16 New approaches to follicular lymphona

With conventional therapy, follicular Iymphona remains incurable for most patients. An experimental approach is therefore justified.Recognition of the association between follicular Iymphona and the (14;18) translocation and the possibility of detecting residual disease at the molecular level using the polymerase chain reaction (PCR), have led to the concept of ‘molecular remission’.Several new approaches, some of which have been reported to result in ‘molecular remission’ eg. the chimaeric antibody antti-CD20 and the combination Fludarabine, Mitoxantrone and Dexamethasone are currently being evaluated at SBH. These and other treatment options, including high dose treatment (Cyclophosphamide + total body irradiation) supported by autologous haemopoietic progenitor cells, radio-labelled anti-CD20 and the nonmyeloablative regimen comprising Fladarabine and Cyclophosphamide supported by allogeneic bone marrow transplantation will be discussed

Fludarabine phosphate for the treatment of low grade lymphoid malignancy.

Thirty-four patients with previously treated, advanced, low grade NHL were treated with Fludarabine, a deamination-resistant analogue of adenosine arabinoside, at a dose of 25 mg m-2 intravenously, daily for 5 days (median number of cycles = 3, range 1-10). Complete remission (CR) was achieved in six and partial remission (PR) in a further seven. Overall, responses were seen in 11/23 patients (48%) with follicular lymphoma and in 2/11 (18%) with low grade, diffuse NHL. Fifteen patients with previously treated CLL and one patient with prolymphocytic leukaemia (PLL) were also treated as above (median no. of cycles = 3, range 1-6). A partial response was seen in three of the 11 evaluable patients with CLL and CR was achieved in the patient with PLL. There were four deaths due to infection and 19 further episodes requiring admission to hospital. No other significant toxicity was reported in a total of 164 cycles of Fludarabine. This agent is active in advanced low grade lymphoid malignancy. Further studies are required to assess its role in newly diagnosed patients