74
F. Ravandi Another question is whether concurrent or se-
quential therapy is the correct strategy to incorporate monoclonal antibody therapy into the management of HCL. In a randomized phase II study by the Cancer and Leukemia Group B (CALGB) in patients with CLL, a higher overall and complete response rate was reported for the group receiving concurrent rituximab and fludarabine as opposed to those receiving the same drugs sequentially [15]. However, at the time of the report, the median response duration or survival had not been reached for either arm of the study. Patients receiving the concurrent treatment had a higher incidence of grade 3 and 4 neutropenia. More recently, Else and colleagues have reported a high response rate in patients with relapsed HCL receiving concurrent rituximab and a nucleoside analog [16]. These data suggest that the concurrent strategy may potentially be more effective in inducing and maintaining CRs, perhaps at the risk of a higher likelihood of neutropenic infections. Large prospective trials are likely needed to answer this question.
Acknowledgements
This study was supported by a grant from the Hairy Cell Leukemia Research Foundation and a research grant from Genentech Pharmaceuticals.
Potential conflict of interest: A disclosure form provided by the author is available with the full text of this article at
www.informahealthcare.com/lal.
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