Fludarabine, cyclophosphamide and mitoxantrone in relapsed or refractory chronic lymphocytic leukemia and low grade non-Hodgkin's lymphoma

A regimen combining fludarabine, cyclophosphamide and mitoxantrone (FCM) was used to treat 29 patients with relapsed or refractory chronic lymphocytic leukemia (CLL, N= 24) and low-grade non-Hodgkin's lymphoma (NHL, N= 5) based on evidence suggesting synergism between the 3 drugs. Patients were treated with mitoxantrone 5 mg/m(2) IV day 1 only, fludarabine 25 mg/m(2) IV for 3 days or 24 mg/m(2) orally for 5 days, cyclophosphamide 250 mg/m(2) IV for 3 days or 150 mg/m(2) orally for 5 days inclusive. Eighteen patients had previously received fludarabine and most were heavily pretreated with 40% having >2 prior treatments. A median number of 4 FCM courses ( range of 1 - 9) were given. The response rate was 78.5%: 32% complete remission, 25% nodular partial remission, 21.5%, partial remission. Median duration of response was 19 months and median survival was 42 months. Sixteen patients (57%) developed neutropenia to <0.5 x 10(9)/ l and 12 (43%) infectious complications. Four patients developed large cell lymphoma ( Richter's syndrome) and 2 acute myeloid leukemia. FCM is a useful combination for relapsed or refractory CLL and low grade NHL with high response rates and long duration of response. The role of FCM as first line therapy deserves study as well as its combination with the monoclonal antibody Rituximab.