Chemotherapy Plus Monoclonal Antibodies

The limited single-agent activity of the monoclonal antibodies has led to combination treatment strategies. The FCR regimen has been shown to have superior activity to other FLU-based regimens.28 In a study of 177 relapsed or refractory patients treated with FCR, the overall remission rate was 73%.29 The median time to progression was 28 months, but 39 months for those patients who achieved a CR.

Another regimen combines the purine analog pen-tostatin 4 mg/m2 with CTX 600 mg/m2 IV on 1 day every month for 6 months. Rituximab 375 mg/m2 is added with the second cycle. This regimen results in an OR rate of 75%, but unlike the FCR regimen, was given with prophylactic antibiotics and routine hematopoietic growth factor support.30

Patients previously treated with purine analogs such as FLU usually remain responsive to purine analogs as long as their disease does not progress or relapse within 6 months of treatment. Those who do progress or relapse with 6 months are considered "FLU refractory" and respond poorly to purine analog-based treatment. These patients are candidates for alemtuzumab or inves-tigational approaches.

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