Fludarabine for Chronic Lymphocytic Leukemia

To the Editor: Rai et al. (Dec. 14 issue) 1 report the results of a long-term, multicenter, randomized trial comparing fludarabine with chlorambucil in previously untreated patients with advanced chronic lymphocytic leukemia (CLL). In their study the treatments were repeated monthly for a maximum of 12 cycles unless patients had progressive disease, a complete remission, or a response that plateaued over two months of treatment. The hematologic toxicity of fludarabine is well established, and most prior studies have reported that fludarabine can be given for a maximum of six cycles. 2 – 5 In our experience, we have not been able to administer . . .