Fludarabine, cyclophosphamide and rituximab as first‐line treatment in patients with newly diagnosed follicular lymphoma. (2nd July 2014)

• Record Type: Journal Article
• Authors: De la Cruz Vicente, Fátima; Carrillo‐Cruz, Estrella; Rodriguez, Maria Sole; Marín Niebla, Ana; Galiana, Maria Luz Martino; Gonzalez, Jose Falantes; Cuadrado, Isabel Montero; Campos, Jose Gonzalez; Tocino, Ildefonso Espigado; Rios‐Herranz, Eduardo; Perez‐Simón, Jose Antonio
• Is Part Of: European journal of haematology. Volume 93:Number 6(2014:Dec.)
• Page Start: 469
• Page End: 475
• Publication Date: 2014-07-02
• Subjects: Hematology -- Periodicals; Blood -- Diseases -- Periodicals; Blood -- Periodicals; 616.15005
• DOI: 10.1111/ejh.12384
• Languages: English
• ISSNs: 0902-4441

Abstract

<abstract abstract-type="main" id="ejh12384-abs-0001"> <title>Abstract</title> <sec id="ejh12384-sec-0001" sec-type="section"> <p>Fludarabine‐based regimens are highly effective as first‐line therapy in patients with follicular lymphoma. Nevertheless, noticeable haematological toxicity has been reported using fludarabine‐based regimens.</p> </sec> <sec id="ejh12384-sec-0002" sec-type="section"> <title>Aim</title> <p>To analyse the combination of low‐dose oral fludarabine and cyclophosphamide plus rituximab (FCR) as induction therapy, followed by rituximab as maintenance therapy.</p> </sec> <sec id="ejh12384-sec-0003" sec-type="section"> <title>Methods</title> <p>We retrospectively analysed 73 patients diagnosed with low‐grade follicular lymphoma treated with two different schemes: attenuated oral (AO) and standard intravenous (SIV) FCR.</p> </sec> <sec id="ejh12384-sec-0004" sec-type="section"> <title>Results</title> <p>Overall response rate (ORR) was 95% (complete response rate, CRR 79.5%, partial response, PR 15.4%). CRR was 84.6% in AO vs. 61.9% in SIV (<italic>P </italic>=<italic> </italic>0.058). 44.4% of patients underwent maintenance therapy. Grade 3–4 toxicities included neutropenia: 65.4%; anaemia: 39.7%; thrombocytopenia: five patients; infectious complications: six patients. There were no treatment‐related deaths. 6.8% had a secondary malignancy. Progression‐free survival (PFS) was 84.6% at 12 yr. The following variables influenced PFS in multivariate analysis: Hb < 12 g/dL [HR 4.7 (95% CI 1.18–18.6)], response after induction [HR 4.9 (95% CI 1.01–24)] for PR vs. CR and [HR 21.27 (95% CI 4.33–104)] for SD/DP vs. CR. OS was 83.1% at 12 yr. The following variables significantly influenced OS in multivariate analysis: not receiving rituximab as maintenance therapy (HR 10.7 (95% CI 1.4–82.5), increased levels of <italic>β</italic>2‐microglobulin [HR 5.2 (95% CI 1.16–23.7)].</p> </sec> <sec id="ejh12384-sec-0005" sec-type="section"> <title>Conclusions</title> <p>FCR allowed us to obtain a high response rate, which translated into promising progression free and overall survival with an acceptable and manageable toxicity profile, especially with the attenuated oral scheme.</p> </sec> </abstract>