High-dose cyclophosphamide and rituximab without stem cell transplant: a feasibility study for low grade B-cell, transformed and mantle cell lymphomas
Douglas E Gladstone, Javier Bolaños-Meade, Carol Ann Huff, Marianna Zahurak, Ian Flinn, Ivan Borrello, Leo Luznik, Ephraim Fuchs, Yvette Kasamon, William Matsui, Jonathan Powell, Hyam Levitsky, Robert A Brodsky, Richard Ambinder, Richard J Jones, Lode J Swinnen, Douglas E Gladstone, Javier Bolaños-Meade, Carol Ann Huff, Marianna Zahurak, Ian Flinn, Ivan Borrello, Leo Luznik, Ephraim Fuchs, Yvette Kasamon, William Matsui, Jonathan Powell, Hyam Levitsky, Robert A Brodsky, Richard Ambinder, Richard J Jones, Lode J Swinnen
Abstract
Relapse after autologous stem cell transplant for low grade B-cell lymphoma is common secondary to ineffective conditioning and/or tumor autograft contamination. We investigated high-dose cyclophosphamide and rituximab without stem cell rescue as first-line or salvage therapy in lymphomas. After establishing safety, accrual was increased to evaluate event-free survival (EFS). Eighty-one adults received rituximab (375 mg/m(2) days 1, 4, 8, 11, 45, 52), cyclophosphamide (50 mg/kg days 15-18), and pegfilgrastim (day 20). Forty-two patients had low grade B-cell lymphoma [grade I/II follicular (69%), transformed lymphoma (17%), other (15%)]: 45% were treated without measurable disease. Thirty-nine patients had mantle cell lymphoma: 82% were treated without measurable disease. All achieved hematopoietic recovery; 46% required brief hospitalizations. The 5-year EFS and overall survival (OS) for patients with low grade B-cell and transformed lymphoma were 40% and 72%, respectively. The 5-year EFS and OS for patients with MCL were 39% and 62%, respectively. This low-toxicity therapeutic approach obviates the need for stem cell products and establishes a platform for future therapies.
Trial registration: ClinicalTrials.gov NCT00278161.
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Source: PubMed