FLUDAP: Salvage chemotherapy for relapsed/refractory aggressive non-Hodgkin's lymphoma

The aim of this study was to investigate the combination of fludarabine pho sphate, dexamethasone, cytosine arabinoside and cis-platinum (FLUDAP) in th e treatment of patients with relapsed/refractory aggressive non-Hodgkin's l ymphoma (NHL). This regimen comprises: dexamethasone 100mg/d continuous inf usion (cont, inf.) d1-3; cytosine arabinoside (ara-C) 1g/m(2)/d cent, inf. d 2,3 fludarabine phosphate 30mg/m(2) short inf. 4hr prior to each 24hr ara -C inf.; cis-platinum 50mg/m(2) 4hr inf at the start of each 24hr ara-C inf . G-CSF (lenograstim, Granocyte(R)) is given at 263 mu g s.c. daily from da y 7 until the neutrophil count reaches 1.0x10(9)/l, The regimen repeats at 21 day intervals. A total of 33 patients were registered (median age 47 yea rs; 24 males, 9 females); the majority (73%) were refractory to their previ ous treatment and most had advanced disease by Ann Arbor stage. Thirteen (3 9%) of the 33 enrolled patients (52% of the 25 fully evaluable patients who received at least 2 courses of FLUDAP) responded to treatment. A maximum r esponse of complete remission was achieved in 5 patients, good partial remi ssion in 3, and partial remission in 5, Twelve patients went on to successf ul stem cell supported intensification therapy. Median survival times were higher in the responding patients, and in those patients transplanted post- FLUDAP. The toxicity associated with the FLUDAP regimen was generally predi ctable; frequently reported severe events included haematological toxicity and infection. In conclusion, the FLUDAP regimen shows promise as a salvage regimen and increases the available therapeutic options in the treatment o f recurrent/refractory aggressive NHL.