Fludarabine Plus Mitoxantrone With and Without Rituximab Versus CHOP With and Without Rituximab As Front-Line Treatment for Patients With Follicular Lymphoma

Abstract

These results indicate that FM is superior to CHOP for front-line treatment of FL and that rituximab is an effective sequential treatment option. However, they also confirm that this superiority is unlikely to translate into either better PFS or OS.

Monoclonal antibodies as therapeutic agents in oncology and antibody gene therapy

“…The combination of rituximab with chemotherapy containing purine analogs, such as fludarabine, further increased the CR rate to 80% [22]. The superiority in achieving CR with combinations containing purine analogs is supported by a trial published in abstract form comparing fludarabine/mitoxantrone with rituximab consolidation to CHOP/rituximab showing CR rates of 87% and 76%, respectively [23]. Recently, there has been increasing interest in using rituximab as a first-line therapy.…”

Long-term complete responses after 131I-tositumomab therapy for relapsed or refractory indolent non-Hodgkin's lymphoma

“…Rituximab has been shown to improve the outcome of patients with previously untreated follicular lymphoma when associated with chemotherapy (Marcus et al, 2005). Several other reports suggest that first line combination of rituximab and anthracyclinecontaining chemotherapy is able to induce very high response rates and prolonged remission, including molecular remission (Hiddemann et al, 2003;Salles et al, 2004;Zinzani et al, 2004;Czuczman et al, 2005). Both chemo-immunotherapy and RIT appear as attractive options for treatment of indolent lymphoma, but the best long-term strategy still needs to be determined.…”

The role of fludarabine in the treatment of follicular and mantle cell lymphoma

“…[52][53][54][55][56] Hematologic toxicity is the primary side effect associated with such treatment, whereas nonhematologic toxicity is rare. In a study conducted by Cohen et al, 56 patients were treated with the FCR chemotherapy regimen (4 -6 cycles of fludarabine 25 mg/m 2 per day for 3 days, cyclophosphamide 250 mg/m 2 per day for 3 days, and rituximab 375 mg/m 2 weekly); hematologic toxicity was noted in 30% of all patients, with 6% of patients developing Grade 3 or 4 neutropenia.…”

“…These results confirmed the findings of previous studies in which similarly high response rates were reported (Table 4). 31,53 Likewise, in various small, nonrandomized trials, high overall response rates have been yielded by the combination of fludarabine and cyclophosphamide (FC). In a study conducted by Flinn et al, 45 FC (fludarabine 20 mg/m 2 per day for 5 days and cyclophosphamide 600 mg/m 2 per day for 1 day) resulted in an overall response rate of 90%.…”

“…To date, such studies have produced encouraging results (Table 6). 53,54,56,69 For example, Cohen et al 56 investigated the activity of the FCR regimen in previously untreated patients with FL and found an overall response rate of 88% (CR rate, 85%), a disease-free survival rate of 63.4%, and an OS rate of 89.2% after 2 years. Similar data were reported by Vitolo et al, 54 who investigated responses to an FND combination (fludarabine 25 mg/m 2 per day for 3 days, mitoxantrone 10 mg/m 2 per day for 1 day, and dexamethasone 20 mg per day for 3 days) administered in conjunction with rituximab (375 mg/m 2 ).…”