Researchers from Spain have reported that Rituxan® (rituximab) and Fludara® (fludarabine) produces complete remissions in 90% of newly diagnosed patients with extranodal marginal-zone lymphomas of the mucosal-associated lymphoid tissue (MALT) type. The details of this study were published in the November 15, 2009 issue of Cancer.[1]

Marginal-zone lymphomas are a relatively uncommon type of B-cell non-Hodgkin’s lymphoma (NHL), comprising approximately 2-4% of all cases. There are about 61,000 new cases of NHL diagnosed annually, of which 1,000-2,000 are marginal zone. Some of these marginal zone lymphomas are in extranodal sites, including the spleen (splenic marginal lymphomas). Marginal-zone lymphomas also fall into the category of MALT lymphomas. MALT lymphomas are frequently associated with gastric Helicobacter Pylori infection. Marginal-zone lymphomas are included in the “low grade” category, and treatments are similar to those for chronic lymphocytic leukemia (CLL) and follicular lymphoma. This generally means initial treatment with Rituxan-based therapy. Recently, Zevalin® (90Yttrium-ibritumomab tiuxetan) has also been found to be highly effective for patients with extranodal MALT B-cell lymphomas who had failed first-line therapy.

The current study included 22 patients with previously untreated extranodal marginal zone MALT B-cell lymphomas who were treated with Rituxan and Fludara. Twelve patients had gastric lymphoma, and 10 had extragastric lymphoma. The overall response rate was 100%, with 90% achieving a complete response. Patients with extragastric disease were slower to respond to treatment than those with gastric disease. The two-year progression free survival for gastric MALT lymphoma was 100% compared with 90% for patients with extragastric MALT lymphoma.

Comments: These data would suggest that there are not many early failures following initial therapy with Rituxan and Fludara. Toxicity appeared to be minimal and mainly hematologic.

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