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Oral high-dose glucocorticoids and Ofatumumab in fludarabine-resistant Chronic Lymphocytic Leukemia

Leukemia volume 26, pages 1144–1145 (2012)Cite this article

Chronic lymphocytic leukemia (CLL) patients who relapse soon after first-line treatment with fludarabine-based chemoimmunotherapy often survive for only a couple of years.1 Glucocorticoids can kill fludarabine-resistant CLL cells in vitro and high-dose glucocorticoids (HDGCs) have activity against such cells in vivo2 perhaps by intercalating into their membranes and interfering with signaling and bioenergetic pathways.3 Rituxan improves the efficacy of HDGCs, and the combination has been reported to induce complete response rates of up to 25%.4, 5

Ofatumumab is a CD20 antibody with binding properties that may confer greater activity against tumors with low CD20 expression such as CLL. Single-agent ofatumumab is reported to have a 40–50% response rate in fludarabine and alemtuzumab refractory disease but only 14% in patients with both bulky (>5 cm) lymph nodes and tumor cells with 17p deletions.1 Ofatumumab is available in Canada through a special access program for CLL patients who are refractory to fludarabine and alemtuzumab or ineligible for the latter on the basis of bulky disease. We report our experience with 13 such patients concomitantly treated with HDGCs.

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Acknowledgements

Ofatumumab was made available by the GlaxoSmithKline special access program and Health Canada.

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Authors and Affiliations

  1. Division of Molecular and Cellular Biology, Sunnybrook Research Institute, Toronto, Canada

    D E Spaner

  2. Department of Medical Biophysics, University of Toronto, Toronto, Canada

    D E Spaner

  3. Sunnybrook Odette Cancer Center, Toronto, Canada

    D E Spaner

  4. Department of Medicine, University of Toronto, Toronto, Canada

    D E Spaner

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  1. D E Spaner
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Correspondence to D E Spaner.

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Spaner, D. Oral high-dose glucocorticoids and Ofatumumab in fludarabine-resistant Chronic Lymphocytic Leukemia. Leukemia 26, 1144–1145 (2012). https://doi.org/10.1038/leu.2011.329

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