Treatment of chronic lymphocytic leukemia with emphasis on total body irradiation

Abstract

The clinical features of chronic lymphocytic leukemia (CLL) are described for 8O consecutive patients with previously untreated disease. A single patient experienced spontaneous remission while the vast majority of patients developed signs and symptoms of progressive disease. The major problem was infectious complications, correlating with immunologic compromise which was readily discernible prior to treatment. Nearly all deaths have resulted from causes related to CLL or a second malignancy, the latter having been observed in 19% of the series to date. Historical methods of treatment have failed to alter the course of disease in CLL and our experience with these patients was identical. However, one-third of patients with active CLL had clinical and hematologic remissions induced by total body irradiation (TBI). These remittors noted return to normal performance status, had markedly prolonged survival, and have demonstrated heretofore unreported recovery from immunologic deficit. This provides evidence for the first time that it is possible to achieve therapeutic responses which modify the natural history of disease and improve the life of patients with progressive, symptomatic CLL.