Accelerated R-COP: A Pilot Study for the Treatment of Advanced Low Grade Lymphomas that Has a High Complete Response Rate

Abstract

This pilot study tested the hypothesis that dose intensity/dose density treatment may improve the response rate and remission duration in patients with advanced low grade lymphomas. Ten patients with low grade lymphomas: follicular lymphoma grades I and II, marginal zone lymphoma, and small cell lymphocytic lymphoma with progressive disease were studied. Patients had an ECOG performance of 0-2, and Stage III and IV disease. Both untreated and previously treated patients with progressive disease were eligible. Patients received a combination of rituximab 375 mg/m², cyclophosphamide 1000 mg/m², and vincristine 1.4 mg/m² (up to a maximal dose of 2 mg), administered by intravenous infusion every two weeks, for ten treatments. prednisone 50 mg was administered every other day orally for thirty days and then tapered over the next thirty days. Granulocyte colony stimulating factor (G-CSF) was administered on days seven to ten following each cycle of chemotherapy. After 5 and 10 cycles, patients were evaluated for response that included imaging with Ct and pet scans. A total of 10 patients (7 untreated and 3 previously treated) were enrolled into this pilot study between May 2003 and July 2004. Untreated patients received an average of 8.3 cycles of therapy (range 5 to 10 cycles). Seven of 7 untreated patients achieved a complete response (CR), and 5 had not relapsed as of 32-43 months later. Previously treated patients received an average of 9.3 cycles of therapy (range 6 to 12 cycles). One of three previously treated patients achieved a complete response and has no evidence of relapse at 29 months. The other two heavily pretreated patients achieved partial responses, lasting 2 and 5 months. Toxicity was mild consisting mainly of parasthesias requiring attenuation of the vincristine dose. There were no instances of neutropenic fever requiring hospitalization. This program is well tolerated with a high CR rate, and may serve as a basis for future trials.

Keywords:

• Accelerated R-COP
• low grade lymphoma
• rituximab
• prednisone
• vincristine
• cyclophosphamide