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Rituximab in Combination With Fludarabine Chemotherapy in Low-Grade or Follicular Lymphoma

From the Roswell Park Cancer Institute, Buffalo, NY; Berlex Laboratories, Richmond; Genentech Inc, San Francisco; and IDEC Pharmaceuticals, San Diego, CA

Address reprint requests to Myron S. Czuczman, MD, Divisions of Hematologic Oncology and Bone Marrow Transplantation, Roswell Park Cancer Institute, Elm and Carlton Sts, Buffalo, NY 14263; e-mail: myron.czuczman{at}roswellpark.org

PURPOSE: To evaluate the safety and efficacy of fludarabine plus rituximab in treatment-naïve or relapsed patients with low-grade and/or follicular non-Hodgkin's lymphoma.

PATIENTS AND METHODS: This was an open-label, single-arm, single-center phase II study enrolling 40 patients. During the first week of the study, patients received two infusions of rituximab 375 mg/m² administered 4 days apart. Seventy-two hours after the second infusion of rituximab, patients received the first of six cycles of fludarabine chemotherapy (25 mg/m²/d for 5 days on a 28-day cycle). Single infusions of rituximab were administered 72 hours before the second, fourth, and sixth cycles of fludarabine, and two infusions of rituximab were given 4 weeks after the last cycle of fludarabine. Treatment duration was 26 weeks.

RESULTS: An overall response rate of 90% (80% complete response rate) was achieved in the intent-to-treat population. Similar response rates were seen in treatment-naïve and previously treated patients. The median duration of response has not been reached at 40+ months. The median follow-up time in this study is 44 months (range, 15 to 66 months). In patients positive for the 14;18 translocation in blood and/or marrow at enrollment, molecular remission was achieved in 88% of cases, with patients remaining negative for up to 4 years to date. Hematologic toxicity was manageable, and except for a 15% incidence of herpes simplex/zoster infections, infectious complications were rare. Nonhematologic toxicities were minimal.

CONCLUSION: Rituximab plus fludarabine was well tolerated and associated with an excellent complete response rate, including molecular remissions, in patients with low-grade or follicular lymphoma.

Supported by Genentech Inc, IDEC Pharmaceuticals, and Berlex Laboratories.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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