Klin Onkol 2003; 16(5): 201-210.
Summary: Follicular lymphoma belongs to the group of low grade B non-Hodkgin’s lymphomas. Since more six decades it has been known as a nosologic unit, but in spite of huge advance in anticancer therapy the prognosis of patients with developed disease can not be influenced so far. The disease is well therapy-sensitive, but perhaps regularly relapses. Therefore hopes lay on new drugs. One of them is fludarabine monophosphate. It has a higher selective affinity to lymphoid cells and except the inhibition of proliferation induces the apoptosis. Fludarabine shows synergism with several other drugs and for all that there is suitable for combining with other cytostatics and with monoclonal antibody rituximab as well. The efficacy of fludarabine is documented by several studies mostly of phase II. In monotherapy it achieves the overall response in 31-84% patients with 9-60% complete remissions (CR) in the indication of follicular lymphoma. Fludarabine-anthracycline combined regimens (type FM, FND) show average overall efficacy about 86% with achievement about 45% complete remissions. Regimens based on fludarabine and cyclophosphamide (type FluCy, FluCyD) reach the overall average response in 91% patients with achievement about 58% CR. Regimens containing fludarabine and rituximab show total efficacy in range 70-95%. Results of fludarabine containing regimens are very encouraging, however is impossible to say, if they project into the extension of overall survival in follicular lymphoma patients. On the other hand fludarabine shows considerable toxic effects. The myelotoxicity is dominating (in 5-33% cases), but the toxicity of the compartement of progenitor cells occurs often. Severe and long-term immunotoxicity is expressed most strongly at the subpopulation of CD4+ cells and followed by the occurence of opportunistic infections.
