Pentostatin, cyclophosphamide and rituximab for previously untreated advanced stage, low‐grade B‐cell lymphomas

Abstract

Summary We conducted a prospective phase II trial of pentostatin, cyclophosphamide and rituximab as initial therapy for patients with previously untreated advanced stage low-grade or indolent B-cell lymphomas (iNHLs). Of 83 evaluable patients, 91·6% attained an overall response and 86·8% a complete or unconfirmed complete response. The 3-year progression-free survival (PFS) and overall survival rates were 73% and 93%, respectively. The 3-year PFS rate was significantly different for different diagnoses (P = 0·01): 83% [95% confidence interval (CI): 0·72, 0·96] for follicular lymphomas, 73% (95% CI: 0·54, 1·0) for marginal zone lymphomas and 61% (95% CI: 0·46, 0·81) for small lymphocytic lymphomas. The most common adverse events were haematological. Of 509 cycles of chemotherapy administered, grade 3 or 4 neutropenia was reported in 68 cycles (13% of cycles administered) and most frequently occurred during cycles 4–6. This is the first report demonstrating the effectiveness of pentostatin, cyclophosphamide and rituximab in patients with previously untreated iNHLs, including those over 60 years of age.

Long‐term overall‐ and progression‐free survival after pentostatin, cyclophosphamide and rituximab therapy for indolent non‐Hodgkin lymphoma

“…A retrospective analysis of 536 patients with treatment‐naive FL found that CR to initial therapy was associated with improved survival (Bachy et al , ). In our study, CR/CRu occurred more frequently in patients with low serum LDH and β2M levels (Samaniego et al , ). In that group of patients, the high CR rates translated into statistically significant, high PFS and OS rates.…”

“…The drug has provided benefits for CLL and iNHL patients, including improved tolerability, reduced myelosuppression and comparable clinical-response rates (Hensel et al, 2005;Ho & Hensel, 2006;Kay et al, 2007;Shanafelt et al, 2007;Tedeschi et al, 2015). In a singlearm prospective phase II trial, we previously demonstrated that pentostatin combined with cyclophosphamide and rituximab (PCR) was well-tolerated, induced strong responses and supported a favourable short-term toxicity profile in previously untreated patients with advanced-stage iNHL (Samaniego et al, 2015). Given those promising early findings, we now provide an update after a median patient follow-up of 108 months.…”

“…Side effects related to the PCR regimen were discussed in our previous paper (Samaniego et al, 2015). Briefly, haematological events were most common.…”

Pentostatin, Cyclophosphamide and Rituximab (PCR) Regimen

“…9 Current guidelines do not list the PCR regimen as one of the regimens for treatment of Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma. 10 It is listed as one of the recommended regimens for first-line treatment of CLL in patients who are less than 65 years old without comorbidities.…”

“…[16][17][18][19] The studies reviewed reported mild (grade 1 or 2) nausea in 25% to 31% of patients 7 ; moderate to severe (grade 3 or 4) nausea or vomiting was reported in 2% to 3% of patients, respectively. 1,5,9 Prophylactic antiemetic therapy with a serotonin antagonist is recommended [16][17][18][19] but may not be required in all patients. One group suggests addition of a neurokinin (NK 1 ) antagonist may be appropriate in some patients.…”