title: Fludarabine, mitoxantrone, dexamethasone (FND) compared with an alternating triple therapy (ATT) regimen in patients with stage IV indolent lymphoma.
abstract: Treatment for patients with stage IV indolent lymphoma ranges from watchful waiting to intensive chemotherapy and stem cell transplantation. In this trial we compared 2 induction regimens followed by 1 year of interferon maintenance therapy. Fludarabine, mitoxantrone (Novantrone), and dexamethasone (FND) were compared with an alternating triple therapy (ATT) regimen (CHOD-Bleo, ESHAP, and NOPP). Maintenance interferon/dexamethasone was given for 1 year in both treatment 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 =.9). The median follow-up is 5.9 years. The 5-year survival rates were 84% with FND and 82% with ATT (P =.9); the 5-year FFS rates were 41% with FND and 50% with ATT (P =.02). In a multivariate analysis, factors predicting for longer FFS were beta(2)-microglobulin less than 3 mg/L (P =.01) and ATT treatment (P =.03). ATT was associated with a substantially higher rate of grade 3-4 toxicities than FND. In conclusion, both regimens were associated with high rates of response and survival. ATT was associated with substantially longer FFS, but it was more toxic than FND.
authors.affiliation: Department of Lymphoma and Myeloma, University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: Apostolia M
authors.initials: AM
authors.lastname: Tsimberidou
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Anas
authors.initials: A
authors.lastname: Younes
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Fredrick B
authors.initials: FB
authors.lastname: Hagemeister
authors.forename: Andreas
authors.initials: A
authors.lastname: Sarris
authors.forename: Jorge
authors.initials: J
authors.lastname: Romaguera
authors.forename: Mark
authors.initials: M
authors.lastname: Hess
authors.forename: Terry L
authors.initials: TL
authors.lastname: Smith
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.forename: Ana
authors.initials: A
authors.lastname: Ayala
authors.forename: Alejandro
authors.initials: A
authors.lastname: Preti
authors.forename: Ming-Sheng
authors.initials: MS
authors.lastname: Lee
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabanillas
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D014750:Vincristine / Q000008:administration & dosage; D001613:beta 2-Microglobulin / Q000032:analysis
chemical_list: D001613:beta 2-Microglobulin; D003561:Cytarabine; D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine; D002945:Cisplatin; D011241:Prednisone; D008775:Methylprednisolone