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

Lenz, Georg; Hiddemann, Wolfgang; Dreyling, Martin

doi:10.1002/cncr.20483

Cited by 31 publications

(18 citation statements)

References 67 publications

(71 reference statements)

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“…7 The magnitude of this clinical problem is increasing as utilization of fludarabine treatment increases in both CLL [8][9][10][11] and indolent lymphoma. [12][13][14][15] We postulate that combining the conventional mobilizing cytokine granulocyte-colony stimulating factor (G-CSF, filgrastim) with other cytokines, for example stem cell factor (SCF, ancestim) could lead to improved mobilization in fludarabineexposed patients. SCF is a glycosylated protein whose class III tyrosine kinase receptor, c-kit, is found on many cells including early to more mature haemopoietic progenitor cells, mast cells and primordial germ cells, some acute myeloid leukemic blast cells, but importantly not on malignant cells in LPDs.…”

Section: Introductionmentioning

confidence: 99%

Stem cell factor and high-dose twice daily filgrastim is an effective strategy for peripheral blood stem cell mobilization in patients with indolent lymphoproliferative disorders previously treated with fludarabine: results of a Phase II study with an historical comparator

et al. 2008

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Fludarabine exposure leads to impaired peripheral blood stem cell (PBSC) mobilization in indolent lymphoproliferative disorders (LPD). We previously reported that only 34% of fludarabine-exposed patients mobilized successfully using granulocyte-colony stimulating factor (G-CSF; median 10 lg/ kg/day) with or without chemotherapy, with unpredictable kinetics and moderate infectious morbidity. Stem cell factor (SCF) plus high-dose twice daily (b.d.) G-CSF may improve mobilization in these patients. SCF 20 lg/kg/day subcutaneously was given from day 1, G-CSF 12 lg/kg b.d. subcutaneously from day 4, apheresis commenced from day 6. Previous study patients served as historical controls. Thirty five patients with indolent LPD were enrolled, median age was 54 years (range 31-66), 66% male, median cumulative prior fludarabine dose was 660 (405-900) mg. Overall, 22 patients (63%) collected X2.0 Â 10 6 /kg PBSC (success), compared to 34% controls (odds ratio (OR) 3.2; 95% confidence interval (CI) (1.2, 9.3); P ¼ 0.021). Median CD34 þ yield overall was 2.3 Â 10 6 / kg (0.53-8.97) from median four (2-6) aphereses. Study patients X50 years mobilized successfully more frequently than controls (58 versus 17%; P ¼ 0.0065). Adjusting for age, successful mobilization remained significantly higher in the current study (OR 4.2; 95% CI (1.4, 14.0); P ¼ 0.008). SCF/high-dose b.d. G-CSF improves PBSC mobilization efficacy after fludarabine exposure, over mobilization using G-CSF as the mobilizing cytokine. This combined growth factor strategy is a preferred mobilization method for fludarabine-exposed patients.

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Section: Introductionmentioning

confidence: 99%

Stem cell factor and high-dose twice daily filgrastim is an effective strategy for peripheral blood stem cell mobilization in patients with indolent lymphoproliferative disorders previously treated with fludarabine: results of a Phase II study with an historical comparator

et al. 2008

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“…Maintenance interferon-alfa therapy following induction regimen has not been proven to improve survival either 45,46 . Fludarabine can also be used in patients with lymphoma with or without rituximab combination 47 . Fludarabine alone in previously treated MCL can induce temporary responses in a third of patients lasting between 4 to 8 months 48 .…”

Section: Role Of Chemotherapymentioning

confidence: 99%

Mantle Cell Lymphoma: Decision Making for Transplant

Koç¹,

Demirer²

2012

New Advances in Stem Cell Transplantation

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“…Fludarabine, a purine analog effective in the treatment of lymphoproliferative disorders, [1][2][3][4] is currently used in preparative regimens for allogeneic stem cell transplantation because of its immunosuppressive properties. 5 In particular, it has been successfully utilized in reduced intensity conditioning (RIC) regimens in combination with drugs such as melphalan, 6,7 thiotepa with or without cyclophosphamide 8,9 or busulfan, 10,11 with low dose total body irradiation (TBI), 12 or in combination with thiotepa and standard TBI in the conditioning regimen for haploidentical transplants.…”

Section: Introductionmentioning

confidence: 99%

Comparable kinetics of myeloablation between fludarabine/full-dose busulfan and fludarabine/melphalan conditioning regimens in allogeneic peripheral blood stem cell transplantation

Chunduri

Dobogai

Peace

et al. 2006

Bone Marrow Transplant

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Fludarabine was utilized in the conditioning regimen of 30 adult patients undergoing an allogeneic hematopoietic stem cell transplant. In 18 patients it was combined with full-dose busulfan (FluBu) as a myeloablative regimen and in 12 cases with melphalan (FluMel) as a reduced intensity conditioning (RIC) regimen. Patients in the FluBu group were younger than in the FluMel group (P ¼ 0.03). Of 30 patients, 24 received peripheral blood stem cells (PBSC) whereas six patients in the FluBu group received bone marrow cells. The hematological toxicity of each regimen was evaluated by analyzing the kinetics of the neutropenia induced by preparative regimens and the time to recovery of the absolute neutrophils count (ANC) and platelets post transplantation. In PBSC transplants, the median day of severe neutropenia (o500 ANC/ll) occurred on day þ 6 after the FluBu regimen and on day þ 3 after FluMel (P ¼ ns), whereas both groups had a duration of severe neutropenia of 9 days and a comparable time for ANC and platelet engraftment. Extra-hematological toxicities were also comparable in the two groups. These findings suggest that the hematological and extra-hematological toxicities induced by fludarabine/full-dose i.v. busulfan are similar to those induced by a standard RIC regimen such as fludarabine/melphalan.

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

Cited by 31 publications

References 67 publications

Stem cell factor and high-dose twice daily filgrastim is an effective strategy for peripheral blood stem cell mobilization in patients with indolent lymphoproliferative disorders previously treated with fludarabine: results of a Phase II study with an historical comparator

Stem cell factor and high-dose twice daily filgrastim is an effective strategy for peripheral blood stem cell mobilization in patients with indolent lymphoproliferative disorders previously treated with fludarabine: results of a Phase II study with an historical comparator

Mantle Cell Lymphoma: Decision Making for Transplant

Comparable kinetics of myeloablation between fludarabine/full-dose busulfan and fludarabine/melphalan conditioning regimens in allogeneic peripheral blood stem cell transplantation

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