BUFFALO, New YorkFinal data from a phase II study of rituximab
(Rituxan) plus fludarabine (Fludara) in low-grade lymphoma show that this
combination is associated with excellent antitumor activity, clears bcl-2-positive
cells from blood and/or bone marrow in most patients, and is well tolerated,
according to Myron S. Czuczman, MD. Dr. Czuczman, who is chief of the
Division of Lymphoma at Roswell Park Cancer Institute in Buffalo, New York,
presented this single-institution study in a poster session at the 43rd
Annual Meeting of the American Society of Hematology.
Single-Institution Study Design
The trial included 40 patients who were either chemotherapy-naive (n =
27) or had previously treated but relapsed low-grade lymphoma (n = 13).
Patients’ median age was 53 years (range: 40-77 years). Histologies
included 27.5% International Working Formulation (IWF) A, 57.5% IWF B, 12.5%
IWF C, and 2.5% IWF D. Fourteen patients (35%) had stage III disease, and 26
(65%) had stage IV disease. Thirty-four of the 40 patients completed
The treatment regimen included seven doses of rituximab (375 mg/m²/dose)
in combination with six cycles of fludarabine (25 mg/m²/d × 5 days, every
28 days). Two infusions of rituximab were given at the beginning and end of
therapy and single infusions were given prior to the second, fourth, and
sixth cycles of fludarabine. Because of hematologic toxicities requiring
treatment discontinuation in two of the first ten patients treated, the
protocol was modified by discontinuing prophylactic
trimethoprim-sulfamethoxazole, reducing the fludarabine dose by 40% for
patients who had grade 4 cytopenia for more than 14 days without growth
factors, and limiting the use of growth factor support. Transient treatment
delays were necessary in 10 of the next 30 patients, but fludarabine dose
reduction was necessary in only 3 of these patients.
Six patients were taken off study. Three had prolonged cytopenia, two had
progressive disease secondary to transformed non-Hodgkin’s lymphoma while
on therapy, and one had pulmonary hypersensitivity.
According to intent-to-treat analysis, the response rate was 90%,
including 80% complete response/unconfirmed complete response (n = 32) and
10% partial response (n = 4). Two patients who completed therapy were not
evaluable for response.