Metronomic Therapy for Multi Relapsed/Refractory Lymphoma. A Pilot Study
Shebli Atrash, Bakhous Aziz, Xenofon Papanikolaou, Abdallah Al-Ola, Muzaffar Jameel, Kumar Surachit, Sarah Waheed, Frits Van Rhee, Saad Z. Usmani and Bart Barlogie
Affiliation: 4301 West Markham Street, Slot 776, Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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.
Keywords: Low dose chemotherapy, lymphoma, metronomic therapy, .
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