Followup Recommendations

The efficacy of pentostatin and 2-CDA and the ability to reinduce patients has influenced our approach to follow-up. During our initial trials of pentostatin, patients routinely had repeat bone marrows while in remission, and retreatment was started with marrow repopulation. However, it has been demonstrated that the patients with a marked degree of marrow infiltration still respond to treatment12,22; thus early treatment is not required.

We see patients after remission induction every 4-6 months, with blood counts and repeat sIL-2R levels performed prior to bone marrow biopsies if there is a change in blood counts. For patients not on protocol, we only perform bone marrows when treatment is indicated. The criteria for retreatment included persistent granulocytopenia <500/^L, platelets <50,000/^L, hemoglobin <10g/dL, painful splenomegaly, and recurrent infections related to immune deficiency. This is more conservative than what is recommended by Goodman et al.,14 who recommend treatment for neutrophils <1000/^L and platelets <100,000/^L. With our criteria, we have had no difficulties retreating patients, and have had no severe complications in patients, being observed without therapy.

0 0

Post a comment