Fludarabine plus cyclophosphamide in Waldenström's macroglobulinemia: results in 49 patients

• Published in: Leukemia Vol. 19; no. 10; pp. 1831 - 1834
• Main Authors: Tamburini, J, Lévy, V, Chaleteix, C, Fermand, J P, Delmer, A, Stalniewicz, L, Morel, P, Dreyfus, F, Grange, M J, Christian, B, Choquet, S, Leblond, V
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01.10.2005; Nature Publishing Group
• Subjects: Aged; Aged, 80 and over; Albumins; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cyclophosphamide; Cyclophosphamide - administration & dosage; Disease Progression; Female; Fludarabine; Hematologic and hematopoietic diseases; Hemoglobin; Hemoglobins - metabolism; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulin M; Immunoglobulin M - metabolism; Immunoglobulinopathies; Immunoglobulins; Immunopathology; Immunoproliferative diseases; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphocytes; Lymphoma; Macroglobulinemia; Male; Malignancy; Medical prognosis; Medical sciences; Middle Aged; Patients; Prognosis; Response rates; Retrospective Studies; Survival Rate; Time Factors; Toxicity; Treatment Outcome; Vidarabine - administration & dosage; Vidarabine - analogs & derivatives; Waldenstrom Macroglobulinemia - drug therapy; France; Paris France; Antineoplastic agent; Human; Immunopathology; Purine nucleotide; Hematology; Malignant hemopathy; Alkylating agent; Oxazaphosphinane derivatives; Cyclophosphamide; Fludarabine; Antimetabolic; Immunoglobulinopathy; Lymphoproliferative syndrome; Nitrogen mustard; macroglobulinemia; Fluorine Organic compounds; Waldenstrom macroglobulinemia
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2403885

Fludarabine (FDR) therapy gives a response rate of about 30% in previously treated patients with Waldenström'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 (30 mg/m2 i.v. D1-D3) and Cy (300 mg/m2 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 >65 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.