Metronomic therapy for multi relapsed/refractory lymphoma. A pilot study

Introduction: Multi relapsed/refractory lymphoma (MRRL) represents a medical challenge in the field of clinical Hematology. All effective treatments have been used upfront and the low performance status that accompanies these patients adds to the toxicity of any subsequent treatment. Clearly a new concept for treatment is warranted aiming towards effectiveness with minimal toxicity. The concept of metronomic therapy (MT) depends on the dispensation of chemotherapy at lower dosages aiming at an antiangiogenic rather than a direct effect on the tumor. Patients and Methods: We performed a non-interventional retrospective review of MRRL patients treated in our institute with metronomic therapy (MT). Results: Between June 2004 and November 2012, nine (9) MRRL patients were treated with MT. Median age was 56 years (range 31-65), median number of prior treatment lines was 6 (range 4-9), 55% (5/9) patients had a previous autologous stem cell transplant, and all had progressive disease before receiving MT. Two (2) patients achieved complete remission (22%), one partial remission (11%), one stable disease (11%) and five (55%) had progressive disease. With a median follow up of 2.5 years, median overall survival and progression free survival were 12.7 and 3.3 months respectively. Hematological toxicity was the most frequentreported treatment related toxicity, nevertheless, no more than grade 3 of nonhematological toxicities were reported. Conclusion: Based on a limited number of patients MT achieved an overall response rate of thirty three percent combined with a favorable toxicity profile thus representing a potentially effective salvage treatment for MRRL.