C(H)OP refractory chronic lymphocytic leukemia patients in whom salvage chemotherapy chosen by evaluating multiple chemotherapeutic drug-resistant factors was remarkably effective

Int J Clin Oncol. 2003 Oct;8(5):326-31. doi: 10.1007/s10147-003-0327-7.

Abstract

It is well known that the expression of anticancer drug-resistant factors is elevated in patients with primary refractory or relapsed chronic lymphocytic leukemia (CLL) who have been treated with chemotherapy. We report here two C(H)OP refractory patients with CLL in whom salvage chemotherapy chosen by evaluating anticancer drug-resistant factors (glutathione-S-transferase-Pi [GST-Pi], glycoprotein [GP]-170, multidrug resistance-associated protein [MRP], and lung resistance protein [LRP]) was remarkably effective. A 71-year-old male patient was refractory to induction therapy with cyclophosphamide, vincristine, and prednisone (COP), and his leukemic cells at diagnosis displayed overexpression of GST-Pi and GP-170. A 74-year-old female patient's condition had been stable; she had received ten courses of COP over 9 years. However, because systemic lymphadenopathies recurred, she was treated with chemotherapy consisting of cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) or dexamethasone, etoposide, ifosphamide, and carboplatin (DeVIC). However, she did not respond at all, and her leukemic cells at recurrence displayed overexpression of GST-Pi. Therefore, we chose for these patients a salvage therapy consisting of dexamethasone and high-dose cytosine arabinoside (Ara C), to which neither GST-Pi nor GP-170 show any drug resistance. In both patients, this salvage therapy proved effective.

Publication types

  • Case Reports

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Drug Resistance, Multiple
  • Drug Resistance, Neoplasm*
  • Female
  • Glutathione Transferase / analysis
  • Glycoproteins / analysis
  • Humans
  • Immunohistochemistry
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*
  • Leukemia, Lymphocytic, Chronic, B-Cell / metabolism
  • Male
  • Multidrug Resistance-Associated Proteins / analysis
  • Neoplasm Proteins / analysis
  • Prednisone / administration & dosage
  • Salvage Therapy*
  • Treatment Failure
  • Vault Ribonucleoprotein Particles
  • Vincristine / administration & dosage

Substances

  • ABCB1 protein, human
  • ATP Binding Cassette Transporter, Subfamily B
  • Glycoproteins
  • Multidrug Resistance-Associated Proteins
  • Neoplasm Proteins
  • Vault Ribonucleoprotein Particles
  • major vault protein
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Glutathione Transferase
  • Prednisone

Supplementary concepts

  • CHOP protocol