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High-dose pulse chlorambucil in advanced, low-grade non-Hodgkin's lymphoma
C S Portlock1, D S Fischer, E Cadman
1Division of Medical Oncology, Yale University School of Medicine, New Haven, CT 06510.
Insights
High-dose pulse chlorambucil effectively treated advanced follicular small cleaved cell lymphoma (FSCL) with minimal toxicity. This oral chemotherapy achieved significant objective responses and prolonged disease-free survival in patients with this low-grade non-Hodgkin's lymphoma.
Area of Science:
- Oncology
- Hematology
- Pharmacology
Background:
- Advanced low-grade non-Hodgkin's lymphoma, particularly follicular small cleaved cell lymphoma (FSCL), presents a therapeutic challenge.
- Palliative treatment options aim to improve quality of life and prolong survival with minimal adverse effects.
Purpose of the Study:
- To evaluate the efficacy and toxicity of high-dose pulse chlorambucil in patients with advanced, low-grade non-Hodgkin's lymphoma.
- To determine objective response rates, pathological complete response, partial response, disease-free survival, and overall survival.
Main Methods:
- Oral administration of high-dose pulse chlorambucil at 16 mg/m2 daily for 5 consecutive days each month.
- Treatment was administered to 33 patients diagnosed with advanced, low-grade non-Hodgkin's lymphoma.
- Median follow-up duration was 4.2+ years.
Main Results:
- 70% of patients achieved an objective response.
- Pathological complete response was observed in 11 of 24 patients with FSCL.
- Median disease-free survival was 28 months, with 60% actuarial survival at 5 years.
Conclusions:
- High-dose pulse chlorambucil demonstrates efficacy as a palliative therapy for advanced FSCL.
- The treatment regimen is associated with minimal toxicity.
- This approach offers a viable option for managing advanced low-grade non-Hodgkin's lymphoma.
Abstract:
High-dose pulse chlorambucil was given orally at a dose of 16 mg/m2 daily for 5 consecutive days each month, as reported by Cadman et al. It was used to treat 33 patients with advanced, low-grade non-Hodgkin's lymphoma. With median follow-up of 4.2+ years, 70% of the patients achieved objective response. Eleven of 24 patients with follicular small cleaved cell lymphoma (FSCL) had pathological complete response; nine of 24 with FSCL and three of seven with small lymphocytic lymphoma had partial response. Median disease-free survival was 28 months. Actuarial survival for all patients was 60% at 5 years from initiation of therapy. Treatment toxicity was minimal. Pulse chlorambucil is an effective and minimally toxic palliative therapy for advanced FSCL.
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