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Prepublished online as a Blood First Edition Paper on August 8, 2002; DOI 10.1182/blood-2001-12-0269.
Submitted December 19, 2001
Accepted July 17, 2002
Fludarabine, mitoxantrone, dexamethasone (FND) compared with an alternating triple therapy (ATT) regimen in patients with stage IV indolent lymphoma
Apostolia M Tsimberidou, Peter McLaughlin*, Anas Younes, Maria A Rodriguez, Fredrick B Hagemeister, Andreas Sarris, Jorge Romaguera, Mark Hess, Terry L Smith, Ying Yang, Ana Ayala, Alejandro Preti, Ming Sheng Lee, and Fernando Cabanillas
Department of Lymphoma-Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
* Corresponding author; email: pmclaugh{at}mail.mdanderson.org.
Treatment for patients with stage IV indolent lymphoma ranges from watchful waiting to intensive chemotherapy and stem cell transplantation. In this trial we compared two induction regimens followed by one year of interferon maintenance therapy. Fludarabine, mitoxantrone (Novantrone) and dexamethasone (FND) was compared with an alternating triple therapy (ATT) regimen (CHOD-Bleo, ESHAP, and NOPP). Maintenance interferon/dexamethasone was given for 1 year in both 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=0.9). The median follow-up is 5.9 years. The 5-year survival rates were 84% with FND and 82% with ATT (p=0.9); the 5-year FFS rates were 41% with FND and 50% with ATT (p=0.02). In a multivariate analysis, factors predicting for longer FFS were ß2-microglobulin <3mg/l (p=0.01) and ATT treatment (p=0.03). ATT was associated with a significantly higher rate of grade III-IV toxicities than FND. In conclusion, both regimens were associated with high rates of response and survival. ATT was associated with significantly longer FFS, but it was more toxic than FND.
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