Salvage chemotherapy using a combination of fludarabine and cyclophosphamide for refractory or relapsing indolent and aggressive non-Hodgkin's lymphomas

Izidore S. Lossos, Ora Paltiel, Aaron Polliack

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

The prognosis of patients with refractory or relapsing non-Hodgkin's lymphoma (NHL) after primary therapy is poor and multi-drug salvage treatments are associated with less than 60% response rates, usually of short duration. Here we report the results of a phase II study using a fludarabine-cyclophosphamide (FAMP-Cy) combination as a salvage failure regimen in refractory and relapsing low-grade (6) and intermediate-grade (9) NHL patients. Fifteen patients, who had received up to 4 regimens prior to therapy with FAMP-Cy were treated with fludarabine (25 mg/ml2) and cyclophosphamide (300 mg/m2) for 3 consecutive days followed by G-CSF (5 μg/kg). The overall response was 74%, 4 achieving complete responses (CR) and 7 partial responses (PR). All patients with low-grade NHL responded (4 CR, 2 PR); 5 patients with intermediate-grade NHL achieved PR lasting for a median of 5 months. The main toxicity encountered was moderate myelosuppression. Three patients had febrile neutropenia, one had drug-induced fever and a single patient developed severe neurotoxicity. Opportunistic infections due to lymphopenia were not seen. The combination of fludarabine and cyclophosphamide used as a salvage regimen showed an impressive response in a small group of heavily pretreated low-grade NHL patients who had previously received a large number of prior regimens. FAMP-Cy had limited effect in a similar group of intermediate-grade NHL patients. Results with this 'failure' regimen are encouraging, however further studies are needed in order to confirm these observations in a larger series of patients.

Original languageEnglish (US)
Pages (from-to)155-160
Number of pages6
JournalLeukemia and Lymphoma
Volume33
Issue number1-2
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

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Keywords

  • Fludarabine
  • Fludarabine + cyclophosphamide
  • Intermediate grade
  • Low grade
  • Lymphoma
  • Refractory
  • Relapsing lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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