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Treatment of Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue Type With Cladribine: A Phase II Study

From the Division of Hematology, Division of Gastroenterology, Institute of Medical Informatics, Statistics and Documentation and Institute of Pathology, Karl-Franzens University of Graz, Graz; Departments of Internal Medicine I, Division of Oncology and Division of Clinical Pathology, University of Vienna, and 3.Med Division, Kaiser Franz Josef-Spital, Vienna; and Internal Medicine S. Veit, Department of Hematology and Oncology, General Hospital Salzburg, Salzburg, Austria.

Address reprint requests to Gerald Jäger, MD, Department of Internal Medicine, Division of Hematology, Karl-Franzens-University, Auenbruggerplatz 38, 8036 Graz, Austria; email: gerald.jaeger{at}kfunigraz.ac.at

PURPOSE: As chemotherapy has not been extensively studied in patients with lymphoma of the mucosa-associated lymphoid tissue (MALT), we initiated a prospective study to evaluate the activity of the nucleoside analog cladribine (2-chlorodeoxyadenosine [2-CdA]) in this disease.

PATIENTS AND METHODS: Patients with histologically verified MALT-type lymphoma were enrolled. 2-CdA was administered at a dose of 0.12 mg/kg body weight on 5 consecutive days, as a 2-hour infusion. Cycles were repeated every 4 weeks for a maximum of six cycles.

RESULTS: Nineteen patients with gastric and seven patients with extragastric MALT lymphoma were enrolled. All patients were chemotherapy-naive, and two had been locally irradiated before systemic relapse of the lymphoma. A total of 102 cycles was administered to our patients (median number of cycles per patient, four). All 25 assessable patients responded to treatment: 21 patients (84%) achieved complete remission (CR) and four patients achieved partial remission. All patients (100%) with gastric presentation, but only three patients (43%) with extragastric presentation, achieved CR. Toxicities were moderate and mainly hematologic and required dose reduction and/or premature discontinuation of therapy in only three cases. Two patients died from vascular events, one shortly after the first cycle because of myocardial infarction and the other from stroke 3 months after the second course. Three patients relapsed after 13, 18, and 22 months and one patient showed progressive disease after 15 months. At present, 24 patients are alive at a median follow-up time of 32 months.

CONCLUSION: Our data demonstrate that 2-CdA is highly effective in inducing CR in 84% of patients with MALT-type lymphoma.

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