Fludarabine therapy in immunocytoma and other low-grade non-Hodgkin's lymphomas

M. Clavio, P. Carrara, M. Spriano, I. Pierri, L. Canepa, M. Miglino, L. Celesti, E. Rossi, R. Ghio, F. Patrone, E. Damasio, M. Gobbi

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Fifteen low-grade non-Hodgkin's lymphomas (LGNHL) received Fludarabine (FLU) at a dosage of 30 mg/sqm daily, for 5 days, every 4 weeks, for a total of 6 cycles. The histotypes were: 5 lymphoplasmacytic-lymphoplasmacytoid, 5 lymphocytic, 3 centroblastic-centrocytic follicular, 1 mycosis fungoides, 1 lymphocytic-immunoblastic. All patients were in stage IV with marrow involvement. Five cases (3 immunocytomas) were treated at diagnosis, 2 with marrow residual disease after a previous first line conventional therapy, 3 in relapse and 5 with refractory disease. Eight out of twelve evaluable patients were responsive to the treatment (66%); 3 reached CR (25%) and 5 PR (42%); 4 cases (33%) were not responsive. The therapeutic outcome was strictly correlated to the disease status and the disease extent but not, in pretreated patients, with the number-of prior chemotherapy regimens; in fact previously untreated and refractory patients showed a quite different response rate (4/4 vs 0/3 response) and both patients treated for minimal marrow disease after a previous therapeutic line reached CR. The best results were obtained in follicular centroblastic-centrocytic lymphoma (2/3 CR), in immunocytoma (4/5 PR) and in lymphocytic lymphoma (2/3 responses). The median response lenght and survival were 14 and 20 months, respectively. Besides the three not evaluable cases five additional patients died for disease progression (4) and infection not correlated to the treatment (1). Seven patients are alive. Toxic effects of treatment were not negligible and included myelotoxicity and possibly a neurologic syndrome characterized by progressive mental deterioration, psychomotor restlessness, worsening mental confusion, coma and death, without focal signs at neurologic examination (in two patients treated for refractory mycosis fungoides and lymphocytic lymphoma). A case of sudden death was also recorded. In conclusion FLU is an effective drug for LG-NHL, at least for follicular centroblastic-centrocytic, lymphocytic lymphoma and immunocytoma, with the best results reached in untreated and relapsed patients or in cases characterized by minimal residual disease after a previous treatment. On the contrary the drug is not likely to be successful with refractory patients. Moreover, in our experience the FLU toxic effects appear remarkable, especially on bone marrow, CNS and possibly heart.

Original languageEnglish
Pages (from-to)257-263
Number of pages7
JournalJournal of Experimental and Clinical Cancer Research
Issue number3
Publication statusPublished - 1994


  • Chemotherapy
  • Fludarabine
  • Lymphomas
  • Toxicity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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