Fludarabine, cyclophosphamide and mitoxantrone in relapsed or refractory chronic lymphocytic leukemia and low grade non-Hodgkin’s lymphoma

A regimen combining fludarabine, cyclophosphamide and mitoxantrone (FCM) was used to treat 29 patients with relapsed or refractory chronic lymphocytic leukemia (CLL, N= 24) and low-grade non-Hodgkin’s lymphoma (NHL, N= 5) based on evidence suggesting synergism between the 3 drugs. Patients were treated with mitoxantrone 5 mg/m(2) IV day 1 only, fludarabine 25 mg/m(2) IV for 3 days or 24 mg/m(2) orally for 5 days, cyclophosphamide 250 mg/m(2) IV for 3 days or 150 mg/m(2) orally for 5 days inclusive. Eighteen patients had previously received fludarabine and most were heavily pretreated with 40% having >2 prior treatments. A median number of 4 FCM courses ( range of 1 - 9) were given. The response rate was 78.5%: 32% complete remission, 25% nodular partial remission, 21.5%, partial remission. Median duration of response was 19 months and median survival was 42 months. Sixteen patients (57%) developed neutropenia to