Fludarabine, mitoxantrone, dexamethasone (FND) compared with an alternating triple therapy (ATT) regimen in patients with stage IV indolent lymphoma

• Published in: Blood 2002-12, Vol.100 (13), p.4351-4357
• Main Authors: Tsimberidou, Apostolia M., McLaughlin, Peter, Younes, Anas, Rodriguez, Maria A., Hagemeister, Fredrick B., Sarris, Andreas, Romaguera, Jorge, Hess, Mark, Smith, Terry L., Yang, Ying, Ayala, Ana, Preti, Alejandro, Lee, Ming-Sheng, Cabanillas, Fernando
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; beta 2-Microglobulin - analysis; Biological and medical sciences; Bleomycin - administration & dosage; Chemotherapy; Cisplatin - administration & dosage; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Disease-Free Survival; Doxorubicin - administration & dosage; Etoposide - administration & dosage; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematologic Diseases - chemically induced; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Non-Hodgkin - drug therapy; Male; Medical sciences; Methylprednisolone - administration & dosage; Middle Aged; Mitoxantrone - administration & dosage; Mitoxantrone - adverse effects; Pharmacology. Drug treatments; Prednisone - administration & dosage; Procarbazine - administration & dosage; Prognosis; Remission Induction; Survival Rate; Vidarabine - administration & dosage; Vidarabine - adverse effects; Vidarabine - analogs & derivatives; Vincristine - administration & dosage
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2001-12-0269

Treatment for patients with stage IV indolent lymphoma ranges from watchful waiting to intensive chemotherapy and stem cell transplantation. In this trial we compared 2 induction regimens followed by 1 year of interferon maintenance therapy. Fludarabine, mitoxantrone (Novantrone), and dexamethasone (FND) were compared with an alternating triple therapy (ATT) regimen (CHOD-Bleo, ESHAP, and NOPP). Maintenance interferon/dexamethasone was given for 1 year in both treatment arms. Endpoints were comparisons of remission rates, survival, failure-free survival (FFS), molecular response rates, and toxicities. One hundred forty-two patients with previously untreated stage IV indolent lymphoma were evaluable (73 on FND; 69 on ATT). The overall response rates were 97% for FND and 97% for ATT (P = .9). The median follow-up is 5.9 years. The 5-year survival rates were 84% with FND and 82% with ATT (P = .9); the 5-year FFS rates were 41% with FND and 50% with ATT (P = .02). In a multivariate analysis, factors predicting for longer FFS were β2-microglobulin less than 3 mg/L (P = .01) and ATT treatment (P = .03). ATT was associated with a substantially higher rate of grade 3-4 toxicities than FND. In conclusion, both regimens were associated with high rates of response and survival. ATT was associated with substantially longer FFS, but it was more toxic than FND.