High-Dose Cyclophosphamide in Hard-to-Treat Patients with B-NHL
For hard-to-treat patients with non-Hodgkin lymphoma, cyclophosphamide administered in one or two cycles can help bridge the period needed to obtain other effective treatments, as inferred from the work of French authors recently published in the European Journal of Haematology.
Introduction
Currently, some patients with relapsed or refractory lymphoma can be indicated for biological treatments or, more recently, cell therapies (CAR-modified T lymphocytes). The availability of these treatments may be time-limited, and in many cases, classical chemotherapy is needed to bridge the time required to obtain biological treatment or prepare CAR-T lymphocytes. In some solid tumors, the administration of high-dose cyclophosphamide is an established procedure. However, data on its use in lymphomas are still limited.
French Experience − Course and Study Results
French doctors have published their experience using high-dose cyclophosphamide in hard-to-treat patients with relapsed or refractory non-Hodgkin lymphoma from B lymphocytes (B-NHL). These patients had previously undergone at least two lines of therapy.
Cyclophosphamide was administered at a dose of 3 g/m2 over two consecutive days, and in patients who responded, the treatment was repeated after 28 days. For patients not refractory to anti-CD20 treatment, rituximab was added to cyclophosphamide at the standard dose.
The study included 42 patients with a median age of 65 years (range 56−70 years), who had previously undergone four lines of treatment (median). 62% of NHL cases were diffuse large B-cell lymphoma (DLBCL), 24% indolent B-NHL, and 14% mantle cell lymphoma (MCL). The overall response to treatment was 45%. Breaking this down by histological types, the overall response to treatment was 50% in patients with DLBCL, 40% in those with indolent B-NHL, and 33% in patients with MCL. Hematological toxicity at grade 3−5 was observed in all patients, and non-hematological toxicity at grade 3−5 was observed in 43% of patients.
Conclusion
According to the authors, this pilot study showed that in hard-to-treat patients with B-NHL, one or two cycles of high-dose cyclophosphamide present a treatment that is acceptably tolerated by patients. This option can serve as a bridge to modern therapies – such as targeted medications or CAR-T lymphocytes.
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Source: Michot J. M., Annereau M., Danu A. et al. High-dose cyclophosphamide for hard-to-treat patients with relapsed or refractory B-cell non-Hodgkin's lymphoma, a phase II result. Eur J Haematol 2020 Apr; 104 (4): 281−290, doi: 10.1111/ejh.13369.
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