alexa Bortezomib Combined with Rituximab, Fludarabine, Mitoxantrone, and Dexamethasone (R-VFND) for the Treatment of Relapsed/Refractory Follicular Lymphoma | Abstract
ISSN: 2167-0870

Journal of Clinical Trials
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Research Article

Bortezomib Combined with Rituximab, Fludarabine, Mitoxantrone, and Dexamethasone (R-VFND) for the Treatment of Relapsed/Refractory Follicular Lymphoma

Anne W Beaven*, Anthony D Sung, David Rizzieri and Zhiguo Li
Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
Corresponding Author : Anne W Beaven
Division of Medical Oncology,
Duke University Medical Center, Durham, NC, USA
Tel:
919-684-8964
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919-684-5325
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Received July 10, 2012; Accepted August 18, 2012; Published August 21, 2012
Citation: Beaven AW, Sung AD, Rizzieri D, Li Z (2012) Bortezomib Combined With Rituximab, Fludarabine, Mitoxantrone, and Dexamethasone (R-VFND) for the Treatment of Relapsed/Refractory Follicular Lymphoma. J Clin Trials 2:120. doi:10.4172/2167-0870.1000120
Copyright: © 2012 Beaven AW, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Pre-clinical data suggests that bortezomib may have a suppressive effect on B-cell lymphoma 2 (bcl- 2), an anti-apoptotic protein over expressed in follicular lymphoma; therefore, the addition of bortezomib to standard chemotherapy may improve the treatment of follicular lymphoma. We conducted this prospective, single-arm, openlabel phase II trial of bortezomib combined with rituximab, fludarabine, mitoxantrone, and dexamethasone (R-VFND) to evaluate the efficacy and safety of this regimen in patients with relapsed/refractory advanced follicular lymphoma. Methods: Twelve patients with relapsed or refractory stage III or IV follicular lymphoma were treated with bortezomib 1.6 mg/m2 day 1 and day 8 in combination with R-FND (rituximab 375 mg/m2 day 1, fludarabine 25 mg/m2 iv days 1, 2, and 3; mitoxantrone 10 mg/m2 iv day 2; and dexamethasone 20 mg/m2 p.o. days 1, 2, 3, 4, and 5). Cycles were repeated every 28 days for a maximum of 8 cycles. Cycles were held for grade 3/4cytopenias and patients were withdrawn if drug was held for more than 2 weeks. Results: Of 11 evaluable patients, 7 had a response (64%) with 4 complete responses (CR) (36%). Two patients remain in CR after 43 months: on after four cycles with no further treatment, the other after three cycles followed by allogeneic hematopoietic stem-cell transplant. Cytopenias were significant: 55% of patients had grade 3-4 neutropenia and 55% had grade 3-4 thrombocytopenia. Four patients (36%) withdrew early due to hematologic adverse events and one patient (9%) due to neuropathy. Conclusion: The addition of bortezomib to R-FND for treatment of follicular lymphoma resulted in a high response rate, but it was not clearly higher than what is expected from R-FND and the cytopenias were severe. Therefore, while bortezomib’s role in the treatment of follicular lymphoma remains to be fully defined, we find it hard to justify further trials with the fludarabine based combination and suggest future studies focus on alternative combinations.

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