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R-DHAP is effective in fludarabine-refractory chronic lymphocytic leukemia

Leukemia volume 24, pages 652–654 (2010)Cite this article

Fludarabine-refractory chronic lymphocytic leukemia (CLL) infers a very poor prognosis, with a median life expectancy of <1 year.1 Although alemtuzumab, the only registered drug for the treatment of fludarabine-refractory CLL, is effective in this patient category, its use is hampered by an increased risk of major opportunistic infections. Also, effectivity is rather low in patients with bulky disease.1 The only means by which enduring remissions in patients with refractory CLL can be achieved is reduced-intensity allogeneic hematopoietic stem cell transplantation (RIST). Response to induction treatment before RIST is found to be an important determinant of long-term outcome as patients with high disease burden, particularly bulky lymphadenopathy at the time of transplantation or poor response to last treatment, have the tendency to relapse more often, whereas patients with progressive disease uniformly fare badly.2 At present, no optimal induction regimen, especially for patients with chemo-refractory disease, has been established.

In relapsed B-cell non-Hodgkin lymphoma the DHAP-regimen (dexamethasone, cytarabine and cisplatin (CDDP)) has been used as an effective salvage treatment and also as induction therapy before (autologous) stem cell transplantation. Moreover, a recent study showed improved efficacy of the addition of the anti-CD20 monoclonal antibody rituximab to a DHAP-based induction regimen.3 Although at present platinum-based therapies are not often used in CLL, these data provide an incentive to investigate its efficacy in relapsed and refractory CLL.

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Acknowledgements

We thank GA Huls, MD PhD (University Medical Center, Groningen), S Hovenga, MD PhD (Nij Smellinghe Hospital, Drachten) and SH Wittebol, MD (Meander Medical Center, Amersfoort) for providing patient data. APK is personally supported by a ‘Veni’-grant from the Netherlands Organization for Health Research and Development.

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Authors and Affiliations

  1. Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands

    S H Tonino, M H van Oers & A P Kater

  2. Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands

    S H Tonino & E Eldering

  3. Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands

    M van Gelder

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  1. S H Tonino
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  2. M van Gelder
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Correspondence to A P Kater.

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Tonino, S., van Gelder, M., Eldering, E. et al. R-DHAP is effective in fludarabine-refractory chronic lymphocytic leukemia. Leukemia 24, 652–654 (2010). https://doi.org/10.1038/leu.2009.240

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