Applying of Fludarabine in One Patient with CLL/PL Prolymphocytic Transformation - One Case Report.

We reported one case of CLL/PL with prolymphocytic transformation and observed the effect of fludarabine on it. The patient was first admitted for nonspecific hematological symptoms. Her bone marrow showed a mixture leukemia cell’s group consisted of 30% prolymphocytes and 50% mature small lymphocytes. Datas of MIC assay were analyzed. Phenotype indicated some prolymphocytic features. The patient was diagnosed as CLL/PL and a traditional chemotherapy regimen mainly consisted of CHOP and leukeran was applied but showed very limited effect. One month later she was admitted once more for aggravating anemia. MIC was examined again and showed a high proportion of 60% prolymphocytes in marrow. Phenotype by FCM indicated a double positive expression of FMC7 and SmIg. The patient was diagnosed as prolymphocytic leukemia transformed from CLL/PL. Chemotherapy based on CVP and leukeran received no good response. So a single-agent regimen of fludarabine (30 mg*m⁻²*d⁻¹ IV for 5 days as one cycle) was tried. After two cycles’ chemotherapy, bone marrow was reevaluated. Proportion of prolymphocytes descended to a level of 1% and a mild bone marrow suppression was accompanied. Nearly half a year’s follow-up showed a sustained blood tri-linage low level and the patient still led an acceptable quality life with packed red cell support once a month.