Significant thrombocytopenia associated with the addition of rituximab to a combination of fludarabine and cyclophosphamide in the treatment of relapsed follicular lymphoma

European Journal of Haematology
Eugen LeoAnthony D Ho

Abstract

Fludarabine in combination with cyclophosphamide is an effective treatment for newly diagnosed as well as relapsed follicular lymphoma. The anti-CD20 antibody rituximab has been employed successfully for the same indications. No such data were available on a combined use of these agents. Therefore, we conducted a phase II study to evaluate the safety and efficacy of a combination of rituximab (375 mg/m2), fludarabine (4 x 25 mg/m2) and cyclophosphamide (1 x 750 mg/m2), for the treatment of relapsed follicular lymphoma. An unexpected, severe hematologic toxicity with significant, prolonged thrombocytopenias WHO grade III/IV in 6 (35%) of 17 patients treated in total occurred, leading to early termination of the trial. Cytologic and serologic analyses point toward a direct toxic effect. Older patients (mean age 64.7 vs. 56.5 yr) were significantly (P = 0.02) more likely to suffer from this toxicity, whereas no other clinical or hematologic parameter differed statistically between the patients suffering from thrombocytopenia and those who did not. The addition of rituximab to fludarabine/cyclophosphamide employed at doses given above in relapsed follicular lymphoma may have led to this increase in thrombocytopenias. Therefore, cau...Continue Reading

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Citations

Nov 21, 2008·Leukemia & Lymphoma·Stefan WilopEdgar Jost
Sep 13, 2014·Leukemia & Lymphoma·Nimish ShahSimon Rule
Oct 16, 2012·Blood Reviews·Matthew A Lunning, Julie M Vose
Sep 13, 2006·British Journal of Haematology·Jecko ThachilBarrie Woodcock
Mar 3, 2010·American Journal of Hematology·Rebecca L OlinCharalambos Andreadis
Mar 8, 2005·Blood Reviews·Maher K Gandhi, Robert E Marcus
Mar 22, 2006·Seminars in Hematology·Anthony D Ho, Manfred Hensel

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