Comparison of chlorambucil and prednisone versus cyclophosphamide, vincristine, and prednisone as initial treatment for chronic lymphocytic leukemia: long-term follow-up of an Eastern Cooperative Oncology Group randomized clinical trial.

Abstract

The Eastern Cooperative Oncology Group (ECOG) conducted a study in which patients with advanced chronic lymphocytic leukemia (CLL) were randomized between a regimen consisting of chlorambucil (30 mg/m2 orally day 1) and prednisone (80 mg orally days 1 to 5) (C + P) administered every 2 weeks and a more intensive regimen of cyclosphosphamide (300 mg/m2 orally days 1 to 5), vincristine (1.4 mg/m2 intravenously [IV] day 1), and prednisone (100 mg/m2 orally days 1 to 5) (CVP) given every 3 weeks. Treatment was continued for up to 18 months to maximal response. Of the 122 eligible patients, 60 received C + P, while 62 received CVP. With a median follow-up of 7 years, there were no significant differences in survival (4.8 v 3.9 years, P = .12), complete remission (CR) rate (25% v 23%; P = .83), or duration of response (2.0 v 1.9 years; P = .78) between C + P and CVP. Toxicity was modest despite the prolonged treatment. The long median survival of 4.1 years for stage III and IV patients is superior to that usually reported. This could stem from continuing treatment to maximal response rather than an increase in intensity of therapy. These results are comparable to those reported with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy by other investigators. The data suggest that intermittent C + P administered to maximal response continues to be the standard treatment approach for advanced CLL.

Chronic Lymphocytic Leukemia: Recent Advances in Diagnosis and Treatment

“…Multiagent therapy is not indicated, as there is additional risk for toxicity without proven benefit. The chemotherapy regimen of cyclophosphamide, vincristine (Oncovin ® ; Eli Lilly and Company, Indianapolis, http://www.lilly.com), and prednisone (Deltasone ® ; Pfizer Pharmaceuticals, New York, http://www.pfizer.com) (CVP) was compared with chlorambucil and prednisone, and no difference in survival was noted after 7 years of follow-up [26].…”

Present and Future Application of Nanoparticle Based Therapies in B-Chronic Lymphocytic Leukemia (B-CLL)

“…1 The anticarcinogenic effect of cruciferous vegetables is attributed to organic isothiocyanates (ITCs), which are present in a variety of edible cruciferous vegetables such as broccoli, watercress, cabbage, and so on (47). Phenethyl isothiocyanate (PEITC) is one of the ITC family of compounds that has attracted a great deal of attention owing to its remarkable cancer chemopreventive activity (48).…”

“…Many different drugs including those like Chlorambucil (CLB) that has been the gold standard B-CLL´s chemotherapeutic treatment preference for years (1), or even those not traditionally considered or used as antineoplastic agents like Hydroxychloroquine (HCQ) (2), can safely be encapsulated inside nanoparticles and specifically be targeted to the selected tumor cells by the coating of monoclonal antibodies in their surface (3,4). In this way all these drugs could be released in a steady manner exclusively into the desired neoplastic cells.…”

Alkylating agents and nucleoside analogues in the treatment of B cell chronic lymphocytic leukemia

“…However, in randomized trials COP leads to inferior or similar results to those obtained after treatment with chlorambucil with prednisone. [34][35][36] …”