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Treatment of Waldenstrom macroglobulinemia with the combination of Fludarabine and cyclophosphamide Results in 21 patients

Treatment of Waldenstrom macroglobulinemia with the combination of Fludarabine and cyclophosphamide Results in 21 patients

Blood 102(11): 288b-289b, November 16

Fludarabine is effective in Waldenstrom macroglobulinemia with a response rate of 30% in previously treated patients. The combination of Fludarabine (FAMP) and cyclophosphamide (Cy) has been shown to be effective in chronic lymphoproliferative disorders such as chronic lymphocytic leukemia. Based on these data, we have administered the combination of fludarabine (25mg/m2 intravenously (IV) -D1-D3 days) and cyclophosphamide (300 mg/m2 IV -D1-D3) every 28 days to 21 pts. There were 14 males and 7 females. The median age was 63 yrs (36-82), hemoglobin level <100g/L in 33% of pts, albumin <40 g/L in 31% of pts, beta2 microglobulin >normal level in 73% of pts. 8 pts were previously untreated. The median of treatment in 13 previously treated pts was 1. FAMP CY was administered every 4 weeks for a median of 4 courses. Partial response was defined by at least 50% reduction of serum monoclonal protein and of tumor infiltrate at all involved sites. 15/21 (71%) pts were in partial response, 4 had stable disease (SD) and 2 had a progressive disease (PD). With a median of follow-up of 7 months (1.5-25.3), one patient relapsed at 19 mths. Two pts received an autologous hematopoietic stem cell transplantation (HSCT) (one in RP, one in SD) at 6 months. One pt received an a genotypic identical allogeneic HSCT in PR at 7 months. Two pts died: one from sepsis with a PD at 3 months after treatment discontinuation, and one in PR from acute myeloid leukemia at 6 months. Neutropenia grade 3-4 or/and thrombocytopenia grade 3-4 were observed in 7 cycles. Other toxicity was a pneumocystis pneumonia. In conclusion, the combination FAMP/Cy led to a high response rate, even in previously treated patients. However several published data have shown that stem cell collection could be unsuccessful after fludarabine-containing regimen The two pts who received autologous HCST had a HSCT graft collected before starting FMP+CY regimen. The use of stem-cell damaging agents has to be reconsidered in a therapeutic strategy including high-dose therapy and autologous HSCT.

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Accession: 035980645

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