Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type with cladribine: a phase II study.
OBJECTIVE
As chemotherapy has not been extensively studied in patients with lymphoma of the mucosa-associated lymphoid tissue (MALT), we initiated a prospective study to evaluate the activity of the nucleoside analog cladribine (2-chlorodeoxyadenosine [2-CdA]) in this disease.


METHODS
Patients with histologically verified MALT-type lymphoma were enrolled. 2-CdA was administered at a dose of 0.12 mg/kg body weight on 5 consecutive days, as a 2-hour infusion. Cycles were repeated every 4 weeks for a maximum of six cycles.


RESULTS
Nineteen patients with gastric and seven patients with extragastric MALT lymphoma were enrolled. All patients were chemotherapy-naive, and two had been locally irradiated before systemic relapse of the lymphoma. A total of 102 cycles was administered to our patients (median number of cycles per patient, four). All 25 assessable patients responded to treatment: 21 patients (84%) achieved complete remission (CR) and four patients achieved partial remission. All patients (100%) with gastric presentation, but only three patients (43%) with extragastric presentation, achieved CR. Toxicities were moderate and mainly hematologic and required dose reduction and/or premature discontinuation of therapy in only three cases. Two patients died from vascular events, one shortly after the first cycle because of myocardial infarction and the other from stroke 3 months after the second course. Three patients relapsed after 13, 18, and 22 months and one patient showed progressive disease after 15 months. At present, 24 patients are alive at a median follow-up time of 32 months.


CONCLUSIONS
Our data demonstrate that 2-CdA is highly effective in inducing CR in 84% of patients with MALT-type lymphoma.
Jäger
Gerald
G
Division of Hematology, Division of Gastroenterology, Institute of Medical Informatics, Statistics and Documentation, Karl-Franzens University of Graz, Graz, Austria. gerald.jaeger@kfunigraz.ac.at
Neumeister
Peter
P
Brezinschek
Ruth
R
Hinterleitner
Thomas
T
Fiebiger
Wolfgang
W
Penz
Melitta
M
Neumann
Hans J
HJ
Mlineritsch
Brigitte
B
DeSantis
Maria
M
Quehenberger
Franz
F
Chott
Andreas
A
Beham-Schmid
Christine
C
Höfler
Gerald
G
Linkesch
Werner
W
Raderer
Markus
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001402:B-Lymphocytes; D017338:Cladribine / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007765:Lacrimal Apparatus / Q000473:pathology; D008099:Liver / Q000473:pathology; D008221:Lymphoid Tissue / Q000187:drug effects* / Q000473:pathology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010306:Parotid Gland / Q000473:pathology; D011446:Prospective Studies; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate
D000970:Antineoplastic Agents; D017338:Cladribine