Low‐dose oral fludarabine plus cyclophosphamide as first‐line treatment in elderly patients with indolent non‐Hodgkin lymphoma

Abstract

SummaryTwenty-five elderly patients with untreated indolent non-Hodgkin lymphoma were treated with oral fludarabine 25 mg/m 2 /d (40 mg total dose) and cyclophosphamide 150 mg/m 2 /d, both for four consecutive days, repeated every 28 d for four cycles. In all, 21 (84%) patients were responsive: 10 patients achieved complete remission while partial response was obtained in 11. During an observation period of 37 months, there was an overall survival rate of 70% and a median event-free survival of 20 months. Haematological and extra-haematological toxicity were mild. This reduceddose Flu-based oral regimen showed good efficacy and was simple to administer on an outpatient basis.

Low‐dose oral fludarabine plus cyclophosphamide in elderly patients with untreated and relapsed or refractory chronic lymphocytic Leukaemia

“…In particular, we observed that the reduced doses given intravenously determined high response rates and negligible toxicity [13]. Subsequently, we observed similar efficacy of an oral FC treatment given to elderly patients with either refractory or with previously untreated LG-NHL at the doses equivalent to the intravenous low-dose regimen [15,23]. Good efficacy of the intravenous low-dose FC regimen was also observed in elderly patients with relapsed CLL [14].…”

“…In fact, several clinical trials have demonstrated that oral Flu is effective and well tolerated, and thus, convenient to use in an outpatient setting [25][26][27]. Indeed, we could confirm the low hospitalization rate of Flu even in combination with Cy, and compliance to treatment was excellent [15,23].…”

“…We addressed these issues in this study by employing the same low-dose oral FC regimen used in LG-NHL [15], and found that the oral regimen determined at least response rates equivalent to the intravenous schedule in CLL [14]. Most interestingly, response rates and quality of responses were even higher in the UT-CLL with up to 100% overall response (OR) and >60% CRu rates.…”

“…In low-grade non-Hodgkin lymphomas (LG-NHL), reduced dose Flu-based regimens have satisfactory clinical activity and low toxicity [13,14]. Recently, we have observed that low doses of the oral formulation of Flu in combination with oral Cy remain highly effective and with low toxicity in elderly patients with LG-NHL [15].…”

Fludarabine-containing chemotherapy for patients with previously untreated low-grade non-Hodgkin's lymphoma

“…To improve the efficacy of fludarabine as a single agent, various combination therapies have been reported to achieve excellent anti-tumor effects and are comparable or superior to fludarabine alone [13]. Fludarabine combination chemotherapy improves clinical response to 70-90% and prolongs PFS in patients with newly diagnosed, relapsed, or refractory low-grade NHL [14-16]. However, there are some limitations to apply fludarabine combination chemotherapy for treating indolent lymphoid malignancies; in particular, this regimen has no survival benefit, causes long-lasting myelosuppression, and increases the risk of opportunistic infections [17, 18].…”