Low-grade non-Hodgkin's lymphoma--development of a new effective combination regimen (fludarabine, mitoxantrone and dexamethasone; FND).

Low-grade lymphoma is the commonest form of lymphoma in the USA and Europe with a long natural history with multiple responses and relapses. The tendency has been to use simple oral medication until patients have more advanced aggressive disease but new agents such as the purine analogues, mitoxantrone and monoclonal antibodies has led to re-evaluation of this approach. As purine analogues inhibit DNA repair in lymphoid cells, a new combination of fludarabine, mitoxantrone, and dexamethasone (FND) has been developed that is well tolerated and very effective. In a phase II study, in 51 patients 47% complete remissions and 47% partial remissions were noted. FND is now being used in a randomization comparative trial with alternating triple therapy as frontline treatment for low-grade lymphoma at the M.D. Anderson Cancer Center with monitoring by polymerase chain reaction for rearrangement of the bcl-2 gene in blood and bone marrow cells. The high activity and low morbidity of FND makes it as attractive as initial therapy for patients.