High-dose pulse chlorambucil: effective therapy for rapid remission induction in nodular lymphocytic poorly differentiated lymphoma.

Eighteen patients with Stage III or IV nodular poorly differentiated lymphocytic lymphoma (malignant lymphoma, infiltrative nodular type, with predominately small cleaved cells) were treated with intermittent high-dose oral chlorambucil (16 mg/m2 daily for five consecutive days each month) for one year. Complete clinical remissions occurred in 78% of these patients and partial remissions in another 17%. Complete remission usually occurred within three months of beginning therapy and with a medial follow-up of 35 months no patient has relapsed. Toxicity, usually hematologic and occurring late in therapy, has been mild, necessitating termination of therapy in only one patient. Review of recent therapy fails to demonstrate a definite long-term advantage of more aggressive treatment regimens. Intermittent high-dose chlorambucil should be further evaluated as therapy for nodular poorly differentiated lymphocytic lymphoma.