TY - JOUR
T1 - Fludarabine based combinations are highly effective as first-line or salvage treatment in patients with Waldenström macroglobulinemia
AU - Peinert, Stefan
AU - Tam, Constantine S.
AU - Prince, H. Miles
AU - Scarlett, John
AU - Wolf, Max M.
AU - Januszewicz, E. Henry
AU - Westerman, David
AU - Seymour, John F.
PY - 2010/12
Y1 - 2010/12
N2 - 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 25mg/m2 days 1-3, cyclophosphamide C 250mg/m2 days 1-3; n = 7), FCR (FC +R 375mg/m2 day 1; n = 18), FM (F + mitoxantrone M 10mg/m2 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.
AB - 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 25mg/m2 days 1-3, cyclophosphamide C 250mg/m2 days 1-3; n = 7), FCR (FC +R 375mg/m2 day 1; n = 18), FM (F + mitoxantrone M 10mg/m2 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.
KW - fludarabine
KW - nucleoside analog
KW - outcome
KW - treatment
KW - Waldenstrm macroglobulinemia
UR - http://www.scopus.com/inward/record.url?scp=78650067819&partnerID=8YFLogxK
U2 - 10.3109/10428194.2010.524326
DO - 10.3109/10428194.2010.524326
M3 - Article
C2 - 20939696
AN - SCOPUS:78650067819
SN - 1042-8194
VL - 51
SP - 2188
EP - 2197
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 12
ER -