Chlorambucil and Rituximab Combination Is Feasible, Active in NHL

[Guest guest]

Br J Haematol. 2003 Oct;123(2):271-7.

Chlorambucil in combination with induction and maintenance rituximab

is feasible and active in indolent non-Hodgkin's lymphoma.

elli G, Laszlo D, Bertolini F, Pastano R, Mancuso P, Calleri A,

Vanazzi A, Santoro P, Cavalli F, Zucca E.

European Institute of Oncology, Milan, Italy.

giovanni.martin

We investigated the toxicity and efficacy of the chimaeric anti-CD20

antibody rituximab in combination with standard-dose chlorambucil in

newly diagnosed and relapsed/refractory indolent B-cell lymphoma

patients.

A total of 29 patients (15 newly diagnosed and 14

relapsed/refractory) with low-grade or follicular B-cell non-

Hodgkin's lymphoma (NHL) were included in this phase II study.

Therapy consisted of chlorambucil 6 mg/m2/d for 6 consecutive weeks

in combination with a standard 4-weekly rituximab administration

schedule in the induction phase. Patients responding to the induction

therapy received four additional cycles with chlorambucil (6 mg/m2/d

for 2 weeks/month) plus rituximab (once a month).

Twenty-six patients (89%) completed the treatment; only one patient

discontinued treatment because of haematological toxicity. At the end

of the study, the dose of chlorambucil had to be reduced in seven

patients (27%) and six patients (23%) required a delay in further

treatment, as a result of toxicity during consolidation therapy.

Only one patient was withdrawn from the study because of progressive

disease; the 27 patients evaluable for response at the end of

consolidation achieved a clinical response (63% complete response and

26% partial response). A significant CD4+ and CD56+ depletion was

observed after induction and during consolidation therapy; two herpes

zoster virus infections and one perianal abscess represented major

infectious morbidities registered during the study.

Based on our preliminary data, the combination of chlorambucil with

rituximab seemed to be well tolerated and active. Its definitive role

in the treatment of low-grade NHL should be further evaluated in

randomized trials.

PMID: 14531908 [PubMed - indexed for MEDLINE]