Fludarabine and Cyclophosphamide with Filgrastim Support in Patients with Previously Untreated Indolent Lymphoid Malignancies

Ian W, Flinn, John C. Byrd, Candis Morrison, et al.
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001

Reviewers: Li Liu, MD
Source: Blood, Volume 96(1): 71-75, (July) 2000

Précis: Triple regimen appears promising for non-Hodgkin's lymphoma and lymphocytic leukemia


Advanced low-grade lymphomas and chronic lymphocytic leukemia (CLL) are relatively indolent, but are incurable with conventional treatments. The median survival duration from diagnosis is 7 to 9 years. The studies using new nucleoside analogs such as fludarabine for the treatment of low-grade lymphomas have shown promising response rates in phase II trials. In this phase II study, the researchers assessed the response rate and associated toxicity of a triple regimen using fludarabine and cyclophosphamide with filgrastim support.


Sixty patients who had previously untreated low-grade or intermediate-grade lymphoid malignancies due to non-Hodgkin's lymphoma (NHL) or CLL were included. The patients received intravenous cyclophosphamide on day 1 and fludarabine on days 1 through 5. Filgrastim was given subcutaneously on day 8. The regimen was repeated every 28 days for 6 cycles or until maximum response had been achieved.


  • Complete responses were observed in 51% and a partial response rate in 41% of patients.
  • Of the 17 patients with CLL, 47% achieved a complete response and 53% had a partial response.
  • Of the 43 patients with NHL, 60% achieved a complete response and 32% had a partial response.
  • Hematopoetic toxicity was mild with filgrastim support.


The combination of fludarabine, cyclophosphamide and filgrastim is a highly active, well-tolerated regimen for patients with low-grade lymphoid malignancies. The long-term complications are still unknown. This triple regimen versus single agent fludarabine is now being evaluated by the Eastern Cooperative Oncology Group in a randomized trial.