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Modified vincristine, doxorubicin, and dexamethasone regimen in the treatment of resistant or relapsed chronic lymphocytic leukemia an eastern cooperative oncology group study
Author(s) -
Friedenberg William R.,
Anderson Janet,
Wolf Barbara C.,
Cassileth Peter A.,
Oken Martin M.
Publication year - 1993
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19930515)71:10<2983::aid-cncr2820711016>3.0.co;2-1
Subject(s) - medicine , vincristine , regimen , dexamethasone , doxorubicin , oncology , chronic lymphocytic leukemia , leukemia , chemotherapy , cyclophosphamide
Background . Thirty‐six patients with relapsing or refractory chronic lymphocytic leukemia were entered into a Phase II study of the Eastern Cooperative Oncology Group. Methods . A modified VAD regimen was given: a 96‐hour infusion of 1.6 mg vincristine and 36 mg/m 2 doxorubicin with dexamethasone 40 mg by mouth daily for 4 days every 3 weeks. The treatment was continued until two cycles beyond maximal response, which was evaluated after two and six cycles. Results . Of the 33 evaluable patients, 7 (21%) achieved a partial response (PR), with no complete remissions. One‐third of the patients (11 of 33) had progressive disease and 15 of 33 (45%) had stable disease, as defined by the National Cancer Institute Working Group criteria. The median duration of PR was 6.5 months, with a median survival time of 14.8 months. A PR was achieved by 3 of 19 patients (16%) who had received prior vincristine±doxorubicin and 4 of 14 patients (28%) who had not received vincristine or doxorubicin. Of the nine patients whose disease was refractory to prior therapy, five (55%) achieved a PR. The neurotoxicity of VAD was reduced by decreasing the frequency of the dexamethasone, but 22 of 36 (61%) patients still became infected. Only one infection (2.8%) was life threatening, and there were no infectious deaths. Conclusions . Because fludarabine has shown superior responses, VAD should be reserved for patients who do not respond to alkylating agents and fludarabine and in whom alternative treatments are not appropriate.