NEW YORK (Reuters Health) Jan 09 - For advanced, untreated indolent B-cell nonfollicular non-Hodgkin lymphomas (INFL), induction with fludarabine, cyclophosphamide, and rituximab, and a short course of rituximab maintenance, is "highly effective," according to Italian researchers.
This heterogeneous group of diseases includes small lymphocytic lymphoma, lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia), and marginal zone lymphoma.
In a December 16 online paper in Cancer, Dr. Luca Baldini of the University of Milan and colleagues noted that treatment for these cancers traditionally has been derived from therapies that work for chronic lymphocytic leukemia (CLL). There is no definitive regimen.
The new study was a phase II trial with 46 evaluable patients. Therapy consisted of six cycles of fludarabine and cyclophosphamide and eight cycles of rituximab, followed by four maintenance doses of rituximab every two months.
Twenty-one patients had small lymphocytic lymphoma (SLL), 19 had lymphoplasmacytic lymphoma, and six had nodal marginal zone lymphoma.
SLL reportedly accounts for no more than 6% of non-Hodgkin lymphomas, or around 400 a year in the U.S. The other two subtypes are even less common.
The overall response rate after maintenance was 89.1%. Of these 41 patients, 47.8% had complete remission, 19.6% had unconfirmed complete remission, and 21.7% had a partial response.
After a median follow-up of 41 months, only one patient had died of disease progression. On intent-to-treat analysis, progression-free survival and failure-free survival were each 90.1%. Overall survival was 97.4%.
Fourteen patients (29.8%) required dose modification because of adverse events. More than half the patients (55.3%) had treatment-related grade 3 and 4 neutropenia.
"Rituximab maintenance plays an important role in reducing residual tumor burden, thereby improving the quality and duration of response," the authors write.
Overall, they conclude, the combination "is the best treatment option for patients with (indolent B-cell nonfollicular lymphomas) to date, producing higher remission and survival rates compared with previous treatment regimens tested in this subset of patients."
SOURCE: http://bit.ly/AehPtN
Cancer 2011.
This heterogeneous group of diseases includes small lymphocytic lymphoma, lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia), and marginal zone lymphoma.
In a December 16 online paper in Cancer, Dr. Luca Baldini of the University of Milan and colleagues noted that treatment for these cancers traditionally has been derived from therapies that work for chronic lymphocytic leukemia (CLL). There is no definitive regimen.
The new study was a phase II trial with 46 evaluable patients. Therapy consisted of six cycles of fludarabine and cyclophosphamide and eight cycles of rituximab, followed by four maintenance doses of rituximab every two months.
Twenty-one patients had small lymphocytic lymphoma (SLL), 19 had lymphoplasmacytic lymphoma, and six had nodal marginal zone lymphoma.
SLL reportedly accounts for no more than 6% of non-Hodgkin lymphomas, or around 400 a year in the U.S. The other two subtypes are even less common.
The overall response rate after maintenance was 89.1%. Of these 41 patients, 47.8% had complete remission, 19.6% had unconfirmed complete remission, and 21.7% had a partial response.
After a median follow-up of 41 months, only one patient had died of disease progression. On intent-to-treat analysis, progression-free survival and failure-free survival were each 90.1%. Overall survival was 97.4%.
Fourteen patients (29.8%) required dose modification because of adverse events. More than half the patients (55.3%) had treatment-related grade 3 and 4 neutropenia.
"Rituximab maintenance plays an important role in reducing residual tumor burden, thereby improving the quality and duration of response," the authors write.
Overall, they conclude, the combination "is the best treatment option for patients with (indolent B-cell nonfollicular lymphomas) to date, producing higher remission and survival rates compared with previous treatment regimens tested in this subset of patients."
SOURCE: http://bit.ly/AehPtN
Cancer 2011.
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