Efficacy of metronomic chemotherapy with oral cyclophosphamide and methotrexate in patients with non-Hodgkin lymphoma: a retrospective analysis at a single institution

Metronomic chemotherapy is an emerging strategy offering a potentially less toxic yet effective treatment modality. We evaluated the efficacy and safety of low-dose metronomic (LDM) chemotherapy in relapsed or refractory non-Hodgkin lymphoma (NHL) by retrospectively reviewing the data of 16 NHL patients who were treated with oral cyclophosphamide plus methotrexate (CM) as LDM chemotherapy. The patients received oral cyclophosphamide (50 mg per day) and oral methotrexate (2.5 mg twice weekly) until disease progression or unacceptable toxicity was noted. Fifteen NHL patients were evaluable in the study. The overall best response rate was 53.3% (2 complete responses and 5 partial responses), with 6.7% of patients achieving stable disease. The median treatment duration was 4.8 months (range, 1.45-25.3 months); the median overall and progression-free survival times were 12.1 and 6.6 months, respectively; and the median response duration was 8.7 months. Only 4 patients were managed with further salvage chemotherapy. The CM regimen was generally well tolerated, and there was no treatment-related mortality. We concluded that metronomic therapy with an oral CM regimen administered for continuous, prolonged periods represents a well-tolerated treatment for recurrent NHL, especially in elderly patients.