title: High-dose cyclophosphamide and rituximab without stem cell transplant: a feasibility study for low grade B-cell, transformed and mantle cell lymphomas.
abstract: Relapse after autologous stem cell transplant for low grade B-cell lymphoma is common secondary to ineffective conditioning and/or tumor autograft contamination. We investigated high-dose cyclophosphamide and rituximab without stem cell rescue as first-line or salvage therapy in lymphomas. After establishing safety, accrual was increased to evaluate event-free survival (EFS). Eighty-one adults received rituximab (375 mg/m(2) days 1, 4, 8, 11, 45, 52), cyclophosphamide (50 mg/kg days 15-18), and pegfilgrastim (day 20). Forty-two patients had low grade B-cell lymphoma [grade I/II follicular (69%), transformed lymphoma (17%), other (15%)]: 45% were treated without measurable disease. Thirty-nine patients had mantle cell lymphoma: 82% were treated without measurable disease. All achieved hematopoietic recovery; 46% required brief hospitalizations. The 5-year EFS and overall survival (OS) for patients with low grade B-cell and transformed lymphoma were 40% and 72%, respectively. The 5-year EFS and OS for patients with MCL were 39% and 62%, respectively. This low-toxicity therapeutic approach obviates the need for stem cell products and establishes a platform for future therapies.
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21287, USA. dgladst1@jhmi.edu
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Gladstone
authors.forename: Javier
authors.initials: J
authors.lastname: Bolaños-Meade
authors.forename: Carol Ann
authors.initials: CA
authors.lastname: Huff
authors.forename: Marianna
authors.initials: M
authors.lastname: Zahurak
authors.forename: Ian
authors.initials: I
authors.lastname: Flinn
authors.forename: Ivan
authors.initials: I
authors.lastname: Borrello
authors.forename: Leo
authors.initials: L
authors.lastname: Luznik
authors.forename: Ephraim
authors.initials: E
authors.lastname: Fuchs
authors.forename: Yvette
authors.initials: Y
authors.lastname: Kasamon
authors.forename: William
authors.initials: W
authors.lastname: Matsui
authors.forename: Jonathan
authors.initials: J
authors.lastname: Powell
authors.forename: Hyam
authors.initials: H
authors.lastname: Levitsky
authors.forename: Robert A
authors.initials: RA
authors.lastname: Brodsky
authors.forename: Richard
authors.initials: R
authors.lastname: Ambinder
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jones
authors.forename: Lode J
authors.initials: LJ
authors.lastname: Swinnen
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005334:Fever / Q000139:chemically induced; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009503:Neutropenia / Q000139:chemically induced; D000069283:Rituximab; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide