Fludarabine based combinations are highly effective as first-line or salvage treatment in patients with Waldenström macroglobulinemia.

Abstract

Treatment with single-agent chemotherapy or rituximab (R) is safe and moderately effective for patients with Waldenström macroglobulinemia (WM). We analyzed the efficacy and toxicity of fludarabine (F)-combinations. Twenty-nine treatment episodes were administered to 27 patients, including FC (F 25 mg/m(2) days 1-3, cyclophosphamide [C] 250 mg/m(2) days 1-3; n = 7), FCR (FC + R 375 mg/m(2) day 1; n = 18), FM (F + mitoxantrone [M] 10 mg/m(2) day 1; n = 3), and FR (n = 1). Patient characteristics were median age 57 years (36-89), 83% male, 10 previously untreated (34%). In total, 123 cycles were administered, a median of four (2-6) per patient. Grade ≥ 3 neutropenia and infections complicated 28% and 3% of cycles, respectively. Responses were achieved in 26 cases (90%), one complete, 23 partial, and two minor. The median progression-free survival was 43.1 months, and at a median follow-up of 66.5 months the actuarial 5- and 10-year overall survival-rates were 88% and 75%, respectively. All 10 previously untreated patients responded (one CR, nine PR), and were alive at a median follow-up of 50 (6-106) months. Three heavily pretreated patients subsequently developed AML/MDS (one fatal) at 56, 61, and 91 months post F-based treatment. F-combination therapy is highly active in WM, both untreated and alkylator-refractory. However, a possible contribution to the cumulative risk of treatment-related MDS/AML requires ongoing monitoring.

• Authors: Stefan Peinert, Constantine S Tam, H Miles Prince, John Scarlett, Max M Wolf, E Henry Januszewicz, David Westerman, John F Seymour
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 51 Issue 12 Pg. 2188-97 (Dec 2010) ISSN: 1029-2403 [Electronic] United States
• PMID: 20939696 (Publication Type: Evaluation Study, Journal Article, Multicenter Study)

Chemical References

• Vidarabine
• fludarabine

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Retrospective Studies
• Salvage Therapy
• Survival Analysis
• Treatment Outcome
• Vidarabine (administration & dosage, adverse effects, analogs & derivatives)
• Waldenstrom Macroglobulinemia (drug therapy, mortality, pathology)