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Article first published online: 11 AUG 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 22, pages 5210–5217, 15 November 2009
How to Cite
Salar, A., Domingo-Domenech, E., Estany, C., Canales, M. A., Gallardo, F., Servitje, O., Fraile, G. and Montalbán, C. (2009), Combination therapy with rituximab and intravenous or oral fludarabine in the first-line, systemic treatment of patients with extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type. Cancer, 115: 5210–5217. doi: 10.1002/cncr.24605
Presented at the 44th Annual Meeting of the American Society for Clinical Oncology, Chicago, Illinois, May 30-June 3, 2008.
We thank Marta Pulido, MD, for editing the article and for editorial assistance.
- Issue published online: 3 NOV 2009
- Article first published online: 11 AUG 2009
- Manuscript Accepted: 22 JAN 2009
- Manuscript Revised: 18 JAN 2009
- Manuscript Received: 4 NOV 2008
- Instituto de Salud Carlos III
- Spanish Ministry of Science and Technology. Grant Number: PI07/0586
- Institut Municipal de Investigació Médica
- Hospital del Mar. Grant Number: ASS/2008
- B cells;
- non-Hodgkin lymphoma;
- mucosa-associated lymphoid tissue;
Currently, there are no consensus guidelines regarding the best therapeutic option for patients with extranodal marginal zone lymphomas of the mucosa-associated lymphoid tissue (MALT) type.
Patients with systemically untreated or de novo extranodal MALT lymphoma received rituximab 375 mg/m2 intravenously on Day 1 and fludarabine 25 mg/m2 intravenously on Days 1 through 5 (Days 1-3 in patients aged >70 years) every 4 weeks, for 4 to 6 cycles. After the first cycle, oral fludarabine could be given orally at 40 mg/m2 on the same schedule. After 3 cycles, a workup was done. Patients who achieved a complete remission (CR) received an additional cycle, and patients who achieved a partial remission (PR) received a total of 6 cycles.
Twenty-two patients were studied, including 12 patients with gastric lymphoma and 10 patients with extragastric MALT lymphoma. Six patients (27%) had stage IV disease. In total, 101 cycles were administered (median, 4 cycles per patients). After the third cycle, 13 patients (62%) achieved a CR, and 8 patients (38%) achieved a PR. Primary extragastric disease was an adverse factor to achieve CR after 3 cycles of chemotherapy (hazard ratio, 23.3; 95% confidence interval, 2.0-273.3). At the end of treatment, the overall response rate was 100%, and 90% of patients achieved a CR. The progression-free survival rate at 2 years in patients with gastric and extragastric MALT lymphoma was 100% and 89%, respectively. Toxicities were mild and mainly were hematologic.
Combination therapy with rituximab and fludarabine is a very active treatment with favorable safety profile as first-line systemic treatment for patients with extranodal MALT lymphoma. Cancer 2009. © 2009 American Cancer Society.