Recently, the high activity of nucleoside analogues as fludarabine (FAMP), 2-chlorodeoxyadenosine (2-CdA) and 2-deoxycoformycin (DCF) in CLL (chronic lymphocytic leukemia) and low-grade NHL (non-Hodgkin’s lymphoma) has caused a new reawakening interest in these diseases. Predominantly FAMP has widely been studied in CLL with impressive remissions rates (RR) of 30-70% including some complete remissions (CR) in refractory or relapsed CLL. In previously untreated patients, the RR is about 80% with a CR rate of up to 60%. These results open new treatment strategies with even a curative intention such as high-dosé chemotherapy combined with autologous stem cell support or alloge-neic stem cell transplantation. The clinical experience with 2-CdA in CLL is limited, but the preliminary results suggest a similar efficacy as FAMP, whereas DCF seems to be less effective. The major treatment-related morbidity is due to myelo- and immunosuppression by long-lasting T-cell depletion, which may facilitate a greater susceptibility of infections including such with opportunistic organisms predominantly in pretreated patients. However, in previously untreated patients no increased incidence of infections has been reported compared to other schedules. The ongoing prospective trials suggest an advantage in progression-free survival (PFS) and possibly overall survival (OS) for FAMP in comparison to conventional therapies. Presently, the position of FAMP and 2-CdA as two extremely active single agents in CLL is that in the second-line therapy, but their appropriate indication will probably be also that in the first-line strategy of CLL. In indolent NHL, FAMP and 2-CDA are high active single agents, too, with RR of 30-75% in pretreated and 65-100% in the first-line therapy. M. Waldenstrøm and follicular lymphomas seem be more sensitive to purine analogues than mantle cell lymphomas. Present trials in CLL and indolent NHL focus on the combination of purine analogues with alkylators or anthracyclines.

Keywords:
Chronic lymphocytic leukemia, Indolent non-Hodgkin’s lymphomas, Fludarabine monophosphate, 2-Chlorodeoxyadenosine, Cladribine, Purine analogues
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© 1997 S. Karger AG, Basel
1997
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