Fludarabine Plus I-131 Tositumomab as Initial Treatment for Follicular Lymphoma: Half of Patients In Remission at Over 10 Years Median Followup.

The sequential combination of chemotherapy and radioimmunotherapy has been shown to be effective front-line treatment for patients with follicular lymphoma (FL). We report ten-year followup results of a phase II trial of abbreviated fludarabine followed by tositumomab and I-131 tositumomab in patients with untreated follicular lymphoma.

Patients with untreated follicular lymphoma received fludarabine 25 mg/m2/d for five days every five weeks for three cycles followed in six to eight weeks by tositumomab and I-131 tositumomab.

Thirty-eight patients were enrolled. One patient was withdrawn due to ineligible histology. The median age of eligible patients was 53 years, median time from diagnosis was 3.5 months, and 43% of patients had a high-risk FLIPI score. Two patients did not receive radioimmunotherapy; one patient had a myocardial infarction during fludarabine and was not evaluable, and one patient had persistent cytopenias following three cycles of fludarabine. All 35 patients that completed the regimen responded (ORR 100%). With a median follow-up of 128.5 months for all 37 eligible patients, the 10-year intent-to-treat overall survival is 69% and the progression-free survival is 51%. Seventeen patients have progressed (range 2–102 months). Sixteen patients remain in remission with no evidence of disease more than ten years from enrollment. Only four patients have relapsed beyond five years. Four patients have developed MDS (range 16–84 months), one of whom evolved to AML.

Fludarabine followed by tositumomab and I-131 tositumomab is very effective at inducing long-lasting complete remissions in FL. The efficacy and long-term safety of sequential chemotherapy plus radioimmunotherapy should continue to be evaluated in the context of the range of therapeutic options for the initial treatment of follicular lymphoma.

Furman:GSK: Speakers Bureau. Leonard:GSK: Consultancy.