title: Immunochemotherapy with rituximab, vincristine and 5-day cyclophosphamide for heavily pretreated follicular lymphoma.
abstract: OBJECTIVE
  Therapeutic options for relapsed or refractory follicular lymphoma include combination chemotherapy, immunotherapy and, for selected patients, autotransplant. Because of the different mechanisms of action and non-overlapping toxicities, combination of rituximab with chemotherapy is a rational approach.
  
  
  METHODS
  30 patients with follicular non-Hodgkin's lymphoma with advanced-stage disease were treated with four cycles of immunochemotherapy with rituximab 375 mg/m2 on day 1, vincristine 2 mg i.v. on day 2 and cyclophosphamide 400 mg/m2 i.v. from days 2 to 6, repeated at 3-week intervals. All patients had received multiple lines of therapy (median 3); 9 (30%) had relapses (2 after high-dose therapy with autologous transplant), and 21 (70%) were in relapse and refractory to salvage treatment (with an anthracycline-containing regimen in 19).
  
  
  RESULTS
  Of 29 patients evaluable for response, 16 (55 %) obtained a complete response (CR) and 3 (10%) a partial response (PR), with an overall response rate of 65% (19/29); 10 patients (35%) achieved less than PR. The median event-free survival was 16.1 months for all patients, being 22.8 months for responders. After a median follow-up of 2 years from the start of therapy (range 6 months to 3.8 years), of 16 patients who achieved CR, 10 remain free of disease.
  
  
  CONCLUSIONS
  The combination of rituximab with vincristine and 5-day cyclophosphamide is able to produce CR in patients with advanced follicular lymphoma, even in patients resistant to third-generation regimens. The regimen designed on the basis of pharmacokinetics of the chimeric antibody seemed important for the clinical efficacy of the combination.
authors: Division of Hematology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. mlazzarino@smatteo.pv.it
authors: Mario
authors: M
authors: Lazzarino
authors: Luca
authors: L
authors: Arcaini
authors: Ester
authors: E
authors: Orlandi
authors: Isabella
authors: I
authors: Iacona
authors: Paolo
authors: P
authors: Bernasconi
authors: Silvia
authors: S
authors: Calatroni
authors: Marzia
authors: M
authors: Varettoni
authors: Luciano
authors: L
authors: Isa
authors: Ercole
authors: E
authors: Brusamolino
authors: Maurizio
authors: M
authors: Bonfichi
authors: Francesco
authors: F
authors: Passamonti
authors: Sara
authors: S
authors: Burcheri
authors: Cristiana
authors: C
authors: Pascutto
authors: Mario
authors: M
authors: Regazzi
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D008297:Male; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D003520:Cyclophosphamide