Journal
LEUKEMIA
Volume 19, Issue 10, Pages 1831-1834Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.leu.2403885
Keywords
macroglobulinemia; fludarabine; cyclophosphamide
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Fludarabine (FDR) therapy gives a response rate of about 30% in previously treated patients with Waldenstrom's macroglobulinemia (WM). The combination of FDR and cyclophosphamide (Cy) has been shown to be effective in chronic lymphoproliferative disorders. We administered the combination of FDR (30mg/m(2) i.v. D1-D3) and Cy (300mg/m(2) i.v. D1-D3) to 49 patients. Median age was 64 years. The median hemoglobin, albumin, beta 2 microglobulin and immunoglobulin M (IgM) levels were 9.9 g/100 ml, 39.6 g/l, 3 mg/l and 24.7 g/l, respectively. In all, 14 patients (29%) had not previously been treated. FDR/Cy was administered every 4 weeks for a median of four cycles. In all, 38 patients (77.6%) had partial responses, nine had stable disease and two had progressive disease. After a median of follow-up of 25 months, six patients relapsed and two patients developed large-cell lymphoma. The median time to treatment failure was 27 months. The main toxicity was hematological. In all, 12 patients died, four from progression, one from large-cell lymphoma, three from infection and four from a second malignancy. Two factors negatively influenced overall and event-free survival, age 465 years and IgM < 40 g/l. The FDR/Cy combination, therefore, gives a high response rate in WM, even in previously treated patients with factors of poor prognosis.
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