Treatment of Refractory T-Cell Chronic Lymphocytic Leukemia with Purine Nucleoside Analogues

This report describes two cases of T-cell chronic lymphocytic leukemia (T-CLL) treated with purine nucleoside analogues. One patient had CD8+, CD3+ large granular lymphocytosis (LGL) producing transfusion-dependent anemia and was refractory to chemotherapy. Treatment with four cycles of fludarabine produced a clinical complete remission and a molecular genetic partial remission that has been durable for > 15 months. The other patient had CD4+ T-prolymphocytic leukemia and was unresponsive to both fludarabine and 2-chlorodeoxyadenosine. Further trials of these agents are warranted in T-CLL, especially the LGL variant.