Source: Cancer Immunity  |  Posted 9 years ago

Sequential combination of fludarabine and CNOP appears to be active and well tolerated in patients with grade I and II follicular lymphoma.

The addition of other active agents such as rituximab to this regimen may further enhance efficacy and is under investigation, report researchers.

A phase II trial of sequential therapy with fludarabine followed by cyclophosphamide, mitoxantrone, vincristine, and prednisone (CNOP) for low-grade follicular lymphomas was undertaken by Dr Nitin Rohatgi and colleagues. Dr Rohatgi is based at the Barrett Cancer Center and the Division of Hematology/Oncology, Department of Medicine, University of Cincinnati, Cincinnati, Ohio, United States.

Twenty seven patients with bulky stage II, stage III, or stage IV follicular lymphoma (grade I or II) were treated with three cycles of fludarabine followed by six to eight cycles of CNOP. Response was assessed after the third cycle of fludarabine and after the fourth, sixth, and eighth cycles of CNOP. Median follow up was 50 months.

Sixty seven percent (18) of the study patients attained a complete response, and 30 percent (eight) were partial responders. This gave an overall response rate of 97 percent.

Median relapse-free survival was 34 months. (Median overall survival was not reached for the entire cohort at last follow-up.) The disease in all patients who achieved only partial response has progressed. However, more than half of those patients who were complete responders remain free of disease progression at 39-84 months of follow-up.

The researchers concluded, "The regimen was well tolerated. The sequential combination of fludarabine and CNOP appears to be active and well tolerated in patients with grade I and II follicular lymphomas. Patients who achieve complete response fare best, and many remain disease-free long term."