Chlorambucil and Prednisone

Chlorambucil is frequently combined with prednisone (30-100 mg/m2 orally) and prescribed on an intermittent schedule, such as five consecutive days of treatment every 2-4 wk. Based on data from a small subset of patients, the combination was thought to be more effective than chlorambucil alone; when compared in clinical trials, no differences in response rates or overall


Table 1

National Cancer Institute-Working Group Criteria for Response in CLL


Complete response Physical examination Symptoms Lymphocytes Neutrophils Platelets Hemoglobin

Bone marrow lymphocytes Bone marrow biopsy Nodular partial response Partial response

Physical examination (nodes, liver, spleen) Plus 1

Neutrophils Platelets Hemoglobin Duration of complete or partial response Progressive disease

Physical examination (nodes, liver, spleen) Circulating lymphocytes Other Stable disease

Normal None

>1.5 x 107|jL >100 x 103/|L >11 g/dL <30%

No nodules or infiltrates

Complete resonse with bone marrow nodules or infiltrates >50% decrease >1.5 x 103/|L

>100 x 103/|L or 50% improvement >11 g/dL >2 mo

>50% increase or new sites >50% increase Richter's syndrome All others survival were reported, and the use of corticosteroids was associated with an increased incidence of infections (1,2,8-10). At present, the major indication for corticosteroid use in CLL is the management of autoimmune hemolytic anemia or thrombocytopenia.

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