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Monday 01 September 2003

Mitoxantrone-cyclophosphamide-rituximab: an effective and safe combination for indolent NHL.

By: Emmanouilides C, Territo M, Menco H, Patel R, Rosen P.

Hematol Oncol 2003 Sep;21(3):99-108

Treatment for extensive indolent lymphoma should combine optimization of efficacy without excessive toxicity. Rituxan may be an ideal agent for combinations with chemotherapy because of its non-cross-resistant toxicity profile and the potential for synergism. We present the results of 32 patients with indolent B-cell NHL who received a novel three-drug combination designed with the intent of preservation of both efficacy and quality of life. Patient characteristics were as follows, median age, 58 years (36-75 years); histology, follicular 16, SLL/CLL five, lymphoplasmacytic six, marginal cell five; relapsed or refractory, 10; untreated, 22. Patients first received cyclophosphamide 800 mg/m(2) and mitoxantrone 8 mg/m(2), iv on the same day, every 3 weeks for two cycles. Subsequently, patients received rituximab followed by mitoxantrone 8 mg/m(2) every 2 weeks for four cycles. The regimen, and particularly rituximab, was extremely well tolerated. Grade I/II, infusion-related toxicity was noted in 10%. Six patients achieved a PR and 23 a CR for an overall response of 90% (95% CI: 79-100%). The actuarial median TTP for all patients was 30 months. Molecular remissions were noted in 8/14 patients tested in CR. We conclude that the cyclophosphamide-mitoxantrone-rituxan (CyMiR) regimen is effective and extremely well tolerated. Furthermore, rituximab infusion-related morbidity is nearly completely eliminated. Copyright 2003 John Wiley & Sons, Ltd.

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