Idarubicin in low-grade non-Hodgkin's lymphomas

The majority of responses produced in patients with low-grade lymphomas are unique among non-Hodgkin's lymphomas (NHL), and even with a more intensive chemotherapy regimen, they are only partial; the very few complete responses which are induced are usually of short duration and do not influence overall survival. There is, therefore, a need for new approaches to the management of low-grade NHLs. Studies are currently in progress to assess the potential benefits in the treatment of NHL offered by new drugs, including fludarabine, idarubicin and 2-chlorodeoxyadenosine. In order to evaluate idarubicin in combination with purine analogs, we used a combination of fludarabine and idarubicin, called the FLU-ID regimen, to treat 10 patients with recurrent low-grade NHL. Of the 10 patients, 2 (20%) achieved complete response, 5 (50%) partial response, and the remaining 3 showed no benefit from the treatment. The 2 CR patients are still in remission after 12 and 14 months, respectively. The median duration of overall survival of all patients was 18 months. These results indicate the efficacy of the FLU-ID regimen in inducing a good remission rate with moderate side effects in recurrent low-grade NHL. On the basis of this pilot study, we planned a cooperative randomized trial for untreated patients.