Salvage chemotherapy using a combination of fludarabine and cyclophosphamide for refractory or relapsing indolent and aggressive non-Hodgkin's lymphomas

The prognosis of patients with refractory or relapsing non-Hodgkin's lympho ma (NHL) after primary therapy is poor and multi-drug salvage treatments ar e associated with less than 60% response rates, usually of short duration. Here we report the results of a phase II study using a fludarabine-cyclopho sphamide (FAMP-Cy) combination as a salvage failure regimen in refractory a nd relapsing low-grade (6) and intermediate-grade (9) NHL patients. Fifteen patients, who had received up to 4 regimens prior to therapy with FAMP-Cy were treated with fludarabine (25 mg/ml(2)) and cyclophosphamide (300 mg/m( 2)) for 3 consecutive days followed by G-CSF (5 mu g/kg). The overall respo nse was 74%, 4 achieving complete responses (CR) and 7 partial responses (P R). All patients with low-grade NHL responded (4 CR, 2 PR); 5 patients with intermediate-grade NHL achieved PR lasting for a median of 5 months. The m ain toxicity encountered was moderate myelosuppression. Three patients had febrile neutropenia, one had drug-induced fever and a single patient develo ped severe neurotoxicity. Opportunistic infections due to lymphopenia were not seen. The combination of fludarabine and cyclophosphamide used as a salvage regim en showed an impressive response in a small group of heavily pretreated low -grade NHL patients who had previously received a large number of prior reg imens. FAMP-Cy had limited effect in a similar group of intermediate-grade NHL patients. Results with this "failure" regimen are encouraging, however further studies are needed in order to confirm these observations in a larg er series of patients.