Activity of fludarabine in previously treated non-Hodgkin's low-grade lymphoma: results of an Eastern Cooperative Oncology Group study.

Hochster, Howard S.; Kim, KyungMann; Green, Michael D.; Mann, Risa B.; Neiman, Richard S.; Oken, Martin M.; Cassileth, Peter A.; Stott, Phillip B.; Ritch, Paul S.; O’Connell, Michael J.

doi:10.1200/jco.1992.10.1.28

Cited by 151 publications

(48 citation statements)

References 10 publications

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“…[28][29][30] Fludara has been shown to be therapeutically efficacious against lymphoid malignancies. [31][32][33][34][35][36][37] In addition, it is an effective immunosuppressive drug 38,39 especially in conjunction with anti-T lymphocyte globulin (ATG), 39,40 and may possibly play a role in reducing the incidence and severity of graft-versus-host disease (GVHD). 41 We have recently demonstrated that it may be possible to achieve durable engraftment of donor hematopoietic stem cells while minimizing procedure-related toxicity using a low intensity conditioning regimen consisting of Fludara, busulfan (BU) and ATG prior to transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilized allogeneic peripheral blood stem cells (alloSCT).…”

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confidence: 99%

Allogeneic peripheral blood stem cell transplantation using a fludarabine-based low intensity conditioning regimen for malignant lymphoma

Nagler¹,

Slavin²,

Váradi³

et al. 2000

Bone Marrow Transplant

170

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Summary:Relapse is a serious complication following high-dose therapy and autologous bone marrow transplantation (ABMT) for malignant lymphoma (ML). Allogeneic transplantation (alloSCT) is a therapeutic option. However, it is associated with a high incidence of transplantrelated organ toxicity and mortality. We recently reported fast engraftment and minimal transplantrelated toxicity, using fludarabine-based conditioning with reduced amounts of chemotoxic drugs prior to alloSCT. We now present our experience with 23 heavily treated high risk ML patients who underwent matched alloSCT following the same low intensity conditioning. The patients (20 male, three female) were aged 13-63 years. Nineteen had NHL and four HD (resistant disease 12, partial remission 11). Five were post ABMT. Twenty-two patients had fully matched sibling donors, and one a fully matched unrelated donor. Engraftment was fast. There was no rejection or nonengraftment. Organ toxicity was moderate with no liver or renal toxicity Ͼgrade II. Four patients developed Ͼgrade II graft-versus-host disease (GVHD). Seven patients died -four of grade III-IV GVHD and severe infections, two of bacterial sepsis, one of pulmonary failure. Ten patients are alive after 22.5 (15-37) months. Survival and disease-free survival at 37 months are both 40%. Probability of relapse is 26%. These encouraging results suggest that alloSCT following fludarabinebased low intensity conditioning in high-risk patients merits further evaluation. Bone Marrow Transplantation (2000) 25, 1021-1028. Keywords: allogeneic; peripheral blood stem cell transplantation; malignant lymphoma; fludarabine; low intensity conditioning regimen High-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT) has gained widespread acceptance as the treatment for aggressive nonHodgkin's lymphoma (NHL) in chemosensitive relapse,

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mentioning

confidence: 99%

Allogeneic peripheral blood stem cell transplantation using a fludarabine-based low intensity conditioning regimen for malignant lymphoma

Nagler¹,

Slavin²,

Váradi³

et al. 2000

Bone Marrow Transplant

170

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“…The primary toxicity of fludarabine is myelosuppression, which may be prolonged in some patients, especially in those receiving higher doses or prolonged therapy [19][20][21]. Given the greater potential for serious myelotoxicity associated with greater fludarabine exposure, a shorter 3-day course may be a safer alternative when given in combination with mitoxantrone.…”

Section: Discussionmentioning

confidence: 99%

“…Phase I and phase II trials of fludarabine in patients with relapsed and refractory follicular lymphomas demonstrated response rates of 30%-60% [19][20][21]. When combined in vitro, fludarabine and mitoxantrone exert synergistic effects [22].…”

Section: Fludarabinementioning

confidence: 99%

The Role of Mitoxantrone in the Treatment of Indolent Lymphomas

et al. 2005

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With the introduction of newer therapeutic approaches, survival in indolent non-Hodgkin's lymphoma (NHL) appears to be improving. Mitoxantrone LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe three regimens that use mitoxantrone in indolent lymphoma. List the NCCN-recommended regimens for the first-line treatment of follicular lymphoma.3. Discuss the side-effect profile of mitoxantrone in combination with other agents for indolent lymphoma.Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com

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“…Identification of new therapeutic agents for patients with relapsed diffuse large cell lymphoma is therefore needed. To date there is limited experience with nucleoside analogs such as fludarabine and cladribine in patients with relapsed or refractory DLBCL where responses have been disappointing (response rates 0-10%) [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Prolonged myelosuppression with clofarabine in the treatment of patients with relapsed or refractory, aggressive non-Hodgkin lymphoma

Blum

Hamadani

Phillips

et al. 2009

Leukemia & Lymphoma

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We evaluated the safety and efficacy of the purine nucleoside analogue, clofarabine, in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL). Six patients with DLBCL (n = 5) or MCL (n = 1) and a median age of 68 years were treated with 40 mg/m 2 clofarabine IV over 2 h for 5 days, repeated every 28 days, for 1-2 cycles. The overall response rate was 50% (complete response = 1, complete response unconfirmed = 1, partial response = 1). Median progression-free survival was 3.5 months (range 1.5-10 months) and the median overall survival was 7.8 months (range 3-31 months). Grade 3-4 neutropenia and thrombocytopenia was universal, with a median of 34 (range 19-55) and 77 (range 0-275) days required for neutrophil and platelet recovery. Grade 3 non-hematologic toxicities included transaminitis, febrile neutropenia, non-neutropenic infections and orthostatic hypotension. Further accrual to the study was terminated due to prolonged Grade 3-4 myelosuppression and orthostatic hypotension in five of six patients. Clofarabine exhibits evidence of single agent activity in relapsed or refractory DLBCL. However, further study with novel administration schedules that maintain this efficacy and limit toxicity is warranted.

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Activity of fludarabine in previously treated non-Hodgkin's low-grade lymphoma: results of an Eastern Cooperative Oncology Group study.

Abstract: Fludarabine is active in patients with previously treated NHL (particularly low-grade histologies). Future studies will examine its activity in combination with other chemotherapeutic agents in previously untreated patients.

Cited by 151 publications

References 10 publications

Allogeneic peripheral blood stem cell transplantation using a fludarabine-based low intensity conditioning regimen for malignant lymphoma

Allogeneic peripheral blood stem cell transplantation using a fludarabine-based low intensity conditioning regimen for malignant lymphoma

The Role of Mitoxantrone in the Treatment of Indolent Lymphomas

Prolonged myelosuppression with clofarabine in the treatment of patients with relapsed or refractory, aggressive non-Hodgkin lymphoma

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