Metronomic Cyclophosphamide and Vinblastine in Refractory Lymphoma

Introduction

A recent phase I report drew attention to the effectiveness of metronomic (daily low-dose oral) CPA and I.V. vinblastine in refractory Hodgkin disease.¹ We used this combination in a patient with Hodgkin lymphoma and extensive prior treatment. The regimen was adapted to include rituximab for another patient who was unfit for R-CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone plus rituximab) therapy due to prior myocardial infarction.

Case 1

A 56-year-old patient had first-line chemotherapy for Hodgkin lymphoma stage IVB in 2004, treated with ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine). A year later a recurrence was treated with stem cell transplantation. He presented in February 2008 with extensive bone metastases, for which 45 Gy radiotherapy was given, also with curative intent. In April 2008 we started with metronomic chemotherapy (cyclophosphamide 50 mg + methylprednisolone 32 mg per day orally, vinblastine 3 mg/m² intravenously [I.V.] 1 × per week) for retroperitoneal lymph node recurrence. This treatment was well tolerated. After 9 months of treatment, there were no lymph nodes detectable on computed tomography scan. Complete remission now lasts > 3 months.

Case 2

An 81-year-old farmer had a myocardial infarction 40 years ago. He presented with cutaneous involvement and axillary lymph node. Biopsy showed a cutaneous involvement by B-cell diffuse large-cell lymphoma. International Prognostic Index score was low. Ejection fraction was 42%. The same chemotherapy was applied (cyclophosphamide 50 mg/d and methylprednisolone 32 mg per day, vinblastine I.V. days 1, 8, 15), but on day 22 of the 28-day cycle, we applied rituximab 375 mg/m². The patient had a complete remission after 4 months of treatment.

Conclusion

These data confirm the effectiveness of this well-tolerated regimen in refractory lymphoma as well as in a lymphoma patient unfit for anthracyclines.

Reference

Young S, Whissell M, Noble JC. Phase II clinical results involving treatment with low-dose daily oral cyclophosphamide, weekly vinblastine, and rofecoxib in patients with advanced solid tumors. Clin Cancer Res 2006; 12; 3092-9.