Purine analogues Efficacy

No RCTs were found. A systematic review of purine analogues in CTCL (1S88-S4) revealed overall and CR rates, respectively, of 41% and 6% for deoxycoformycin (n = 63), 41% and 1S% for 2-chlorodeoxyadenosine (n = 27), and 1S% and 3% for fludarabine (n = 31).5S Most of these studies included some patients with peripheral T-cell lymphomas. No comparative studies were available.

A prospective open study of deoxycoformycin in 28 heavily pretreated patients, of whom 21 had CTCL (14 Sezary syndrome, seven stage IIB) revealed an OR rate of 71%, with 25% CR and 46% PR (OR: 10/14 patients with Sezary syndrome; four CR, and 4/7 stage IIB patients; one CR). Response was short lived (median duration of 2 months for stage IIB disease and 3-5 months for Sezary syndrome) except in two cases of Sezary syndrome with remissions for 17 and 1S months. The regimen consisted of starting doses of 3-75-5-0mg/m2/day for 3 days every 3 weeks. A dose escalation to 6-25 mg/m2/day was rarely possible because of toxicity.80

Two recent open studies of deoxycoformycin in CTCL (27 mycosis fungoides and 37 Sezary syndrome) patients have shown OR rates ranging from 35% to 56%, with CR rates from 10% to 33% and a reported median disease-free interval of S months in one of the studies.81,82 Interestingly, responses were better in Sezary syndrome than mycosis fungoides. The usual schedule for deoxycoformycin consists of a once-weekly intravenous dose of 4 mg/m2 for 4 weeks and then every 14 days for either 6 months or until maximal response.

Combination therapy consisting of deoxycoformycin and alfa interferon in CTCL has shown OR and CR rates of 41% and 5%, respectively.83

A recent phase II trial of 2-chlorodeoxyadenosine in 21 refractory CTCL patients (mycosis fungoides IIB/IV and Sezary syndrome) revealed an OR rate of 28%, with 14% CR (median duration of 4-5 months) and 14% PR (median duration of 2 months).84

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