Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Fludarabine combination therapy for follicular lymphoma followed by acute myeloid leukemia: two further case records

Leukemia volume 22, pages 1781–1782 (2008)Cite this article

The risk of secondary myelodysplastic syndromes/acute myeloid leukemia (tMDS/AML) after lymphoma treatment is still a matter of discussion, but a recent review concluded that it may reach 10% within 10 years of primary therapy.1 Fludarabine-containing regimens have been reported to increase the risk of secondary myeloid neoplasia, particularly when combined with alkylating agents.2 From our series of 156 lymphoma patients, we identified 19 consecutive patients who had received combination chemotherapy containing fludarabine (25 mg m−2 for days 1–3), plus novantrone (10 mg m−2 for day 1) and dexamethasone (20 mg for days 1–5 every 4 weeks) (FND) or fludarabine (25 mg m−2 for days 1–3) and cyclophosphamide (250 mg m−2 for days 1–3), with or without rituximab (r). Clinical characteristics of the selected cohort are reported in Table 1.

Table 1 Patients' clinical characteristics
Full size table

The mean and median follow-up for the entire group was 53 and 50 months, respectively. Two patients who were lost to follow-up were censored at the time of the last visit. The two cases complicated by secondary myeloid disorder were observed and briefly described.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Armitage JO, Carbone PP, Connors JM, Levine A, Bennett JM, Kroll S . Treatment-related myelodysplasia and acute leukemia in non-Hodgkin's lymphoma patients. J Clin Oncol 2003; 21: 897–906.

    Article  Google Scholar 

  2. Morrison VA, Rai KR, Peterson B, Kolitz JE, Elias L, Appelbaum FR et al. Therapy-related myeloid leukemias are observed in patients with chronic lymphocytic leukemia after treatment with fludarabine and chlorambucil: results of an intergroup study, cancer and leukemia group B 9011. J Clin Oncol 2002; 20: 3878–3884.

    Article  Google Scholar 

  3. Au WY, Chan LC, Liang R, Kwong YL . Myelodysplastic syndrome and acute myeloid leukemia after treatment with fludarabine, mitoxantrone, and dexamethasone. Am J Hematol 2006; 81: 471–473.

    Article  Google Scholar 

  4. McLaughlin P, Estey E, Glassman A, Romaguera J, Samaniego F, Ayala A et al. Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma with fludarabine, mitoxantrone, and dexamethasone (FND) plus rituximab and interferon alpha. Blood 2005; 105: 4573–4575.

    Article  CAS  PubMed  Google Scholar 

  5. Constantine S, Tam CS, Seymour JF, Prince HM, Kenealy M, Wolf M et al. Treatment-related myelodysplasia following fludarabine combination chemotherapy. Haematologica 2006; 91: 1546–1550.

    Google Scholar 

  6. Le Beau MM, Albain KS, Larson RA, Larson RA, Vardiman EM, Davis EM et al. Clinical and cytogenetic correlations in 63 patients with therapy-related myelodysplastic syndromes and acute nonlymphocytic leukemia: further evidence for characteristic abnormalities of chromosomes no. 5 and 7. J Clin Oncol 1986; 4: 325–345.

    Article  CAS  Google Scholar 

  7. Zinzani PL, Pulsoni A, Perrotti A, Soverini S, Zaia F, De Renzo A et al. Fludarabine plus mitoxantrone with and without rituximab versus CHOP with and without rituximab as frontline treatment for patients with follicular lymphoma. J Clin Oncol 2004; 22: 2654–2661.

    Article  CAS  Google Scholar 

  8. Solal-Celigny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R et al. Follicular lymphoma international prognostic index. Blood 2004; 104: 1258–1265.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Oncologia e Oncoematologia, Ospedale S. Giuseppe Empoli, Empoli, Italy

    P Bernardeschi, G Fiorentini, P Dentico, S Rossi, G Turrisi, A Del Conte & P G Giannessi

  2. Anatomia Patologica, Ospedale S. Giuseppe Empoli, Empoli, Italy

    G Giustarini

  3. Laboratorio Analisi, Ospedale S. Giuseppe Empoli, Empoli, Italy

    I Montenora

Authors
  1. P Bernardeschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Fiorentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Dentico
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Turrisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Del Conte
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P G Giannessi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G Giustarini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I Montenora
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P Bernardeschi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bernardeschi, P., Fiorentini, G., Dentico, P. et al. Fludarabine combination therapy for follicular lymphoma followed by acute myeloid leukemia: two further case records. Leukemia 22, 1781–1782 (2008). https://doi.org/10.1038/leu.2008.51

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2008.51

Search

Advanced search

Quick links