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2-Chlorodeoxyadenosine alone and in combination for previously untreated Waldenstrom's macroglobulinemia.

Abstract
Treatment for Waldenstrom's macroglobulinemia (WM) has usually been reserved for symptomatic patients and has included alkylating agent-steroid combinations and, more recently, nucleoside analogues. We now describe our experience with 2-chlorodeoxyadenosine (2-CdA) alone and in combination at our center. We treated 90 consecutive, previously untreated patients with symptomatic WM using either 2-CdA alone or in combination with other agents including prednisone (pred), cyclophosphamide (Cy), and rituximab (Rit) as follows: January 1991 to December 1992- 2-CdA 0.1 mg/kg by continuous infusion (CI) over 24 hours for days (16 patients); December 1992 to December 1995-2-CdA 0.1 mg/kg CI over 24 hours for 7 days plus pred 60 mg/m(2) orally daily for 7 days (20 patients); July 1996 to March 1998-2-CdA 1.5 mg/m(2) by subcutaneous injection (SC) every 8 hours for 7 days plus Cy 40 mg/m(2) orally twice daily for 7 days (37 patients); August 1999 to December 2001-2-CdA 1.5 mg/m(2) SC every 8 hours for 7 days plus Cy 40 mg/m(2) orally twice daily for 7 days plus Rit 375 mg/m(2) by intravenous infusion (IV) weekly for 4 weeks (17 patients). For nearly all patients, a second course was repeated after at least 6 weeks. Responding patients were monitored without further treatment until relapse. Overall response (complete [CR] + partial response [PR]) was 94% for 2-CdA alone, 60% for 2-CdA/pred, 84% for 2-CdA/Cy, and 94% for 2-CdA/Cy/Rit. Median overall survival is 73 months for 2-CdA, 41 months for 2-CdA/pred, and has not been reached for 2-CdA/Cy or 2-CdA/Cy/Rit. Cause-specific survival for 2-CdA/pred is 78 months and has not been reached for all other programs. The only poor prognostic factor for cause-specific survival was hemoglobin < 9 g/dL. 2-CdA regimens provide excellent response rates and improve cause-specific survival, with minimal treatment and little toxicity. These observations support the potential role of 2-CdA regimens as the treatment of choice for previously untreated WM.
AuthorsDonna M Weber, Meletios A Dimopoulos, Kay Delasalle, Kim Rankin, Maria Gavino, Raymond Alexanian
JournalSeminars in oncology (Semin Oncol) Vol. 30 Issue 2 Pg. 243-7 (Apr 2003) ISSN: 0093-7754 [Print] United States
PMID12720145 (Publication Type: Journal Article)
CopyrightCopyright 2003 Elsevier Inc. All rights reserved.
Chemical References
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents
  • Glucocorticoids
  • Cladribine
  • Rituximab
  • Cyclophosphamide
  • Prednisone
Topics
  • Aged
  • Antibodies, Monoclonal (administration & dosage)
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents (therapeutic use)
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Cladribine (administration & dosage, therapeutic use)
  • Cyclophosphamide (administration & dosage)
  • Glucocorticoids (therapeutic use)
  • Humans
  • Middle Aged
  • Prednisone (therapeutic use)
  • Prognosis
  • Remission Induction
  • Rituximab
  • Survival Analysis
  • Waldenstrom Macroglobulinemia (blood, drug therapy)

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