title: A phase 2 study of concurrent fludarabine and rituximab for the treatment of marginal zone lymphomas.
abstract: The marginal zone lymphomas (MZLs) are a recently defined group of related diseases that probably arise from a common cell of origin, the marginal zone B cell. Data on therapy for subtypes other than gastric mucosa-associated lymphoid tissue (MALT) lymphoma has been largely limited to retrospective case series. This prospective phase 2 study of fludarabine and rituximab for the treatment of marginal zone lymphomas enrolled 26 patients, 14 with nodal MZL, eight with MALT lymphomas and four with splenic MZL; 81% were receiving initial systemic therapy. Only 58% [95% confidence interval (CI) 37-77%] of patients completed the planned six cycles, due to significant haematological, infectious and allergic toxicity. Four late toxic deaths occurred due to infections [15% (95% CI 4.3-35%)], two related to delayed bone marrow aplasia and two related to myelodysplastic syndrome. Nonetheless, the overall response rate was 85% (95% CI 65-96%), with 54% complete responses. The progression-free survival at 3.1 years of follow-up is 79.5% (95% CI 63-96%). We conclude that, although concurrent fludarabine and rituximab given at this dose and schedule is a highly effective regimen in the treatment of MZLs, the significant haematological and infectious toxicity observed both during and after therapy is prohibitive in this patient population, emphasizing the need to study MZLs as a separate entity.
authors.affiliation: Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. jbrown2@partners.org
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Brown
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.forename: Yang
authors.initials: Y
authors.lastname: Feng
authors.forename: Sarah
authors.initials: S
authors.lastname: Scofield
authors.forename: Kimberly
authors.initials: K
authors.lastname: Phillips
authors.forename: Paola
authors.initials: P
authors.lastname: Dal Cin
authors.forename: Robin
authors.initials: R
authors.lastname: Joyce
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Takvorian
authors.forename: David C
authors.initials: DC
authors.lastname: Fisher
authors.forename: Richard I
authors.initials: RI
authors.lastname: Fisher
authors.forename: Jane
authors.initials: J
authors.lastname: Liesveld
authors.forename: Diana
authors.initials: D
authors.lastname: Marquis
authors.forename: Donna
authors.initials: D
authors.lastname: Neuberg
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Freedman