Fludarabine (FLU) alone or in combination has been reported to be effective in recurrent LGL. But granulocytopenia and infection occurred. We report two successive studies in which FLU was combined with cyclophosphamide (CY) and with CY plus mitoxantrone (MITO). Fifty-three successive patients with recurrent LGL (R.E.A.L. classification) entered studies. Patients: median age 56 years (range 35 to 75); stage II 5 pts.. Stage HI-IV 48 pts.; relapse after CR 20 pts., PR in progression 21 pts., NR 6 pts., PD 6 pts. Twenty-two patients received FLU/CY treatment (FLU 25 mg/m2 days 1 to 3, CY 300 mg/m2 days 1 to 3), and 31 patients FLU/CY/MITO treatment (FLU 25 mg/m2 days 1 to 3, CY 300 mg/m2 days 1 to 3, MITO 10 mg/m2 day 1). Courses were given every 4 weeks for a maximum of 6 courses. Patients received antibiotic prophylaxis throughout treatment and growth factor (G-CSF) when grade III granulocytopenia (WHO) occurred. Thirty-one patients achieved CR (58%) and 16 PR (30%), with an overall response rate of 88%. Response was similar in both groups (FLU/CY: CR 55%, PR 41%; FLU/CY/ MITO: CR 61%, PR 23%). After 3 courses, 58% of overall CR were achieved in FLU/CY treatment and 90% in FLU/CY/ MITO treatment (p = .02). Granulocytopenia occurred in 79% of patients, grade III-IV was observed in 21% of chemotherapy courses and had a similar distribution between the two treatments. Only 5 patients had a therapeutic delay. Few febrile episodes occurred without infection. However, 1 patient died of sepsis of unknown origin three months after six courses of treatment. Both treatments were effective in recurrent low-grade NHL. The fast activity of FLU/CY/ MITO treatment suggests the clearer usefulness of this schedule. The antibiotic prophylaxis with G-CSF support seems to reduce treatment-related infection.
|Issue number||11 PART I|
|Publication status||Published - 2000|
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