+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn

+ Translate
+ Recently Requested

Treatment of Waldenstrom's macroglobulinemia with the combination of fludarabine and cyclophosphamide

Treatment of Waldenstrom's macroglobulinemia with the combination of fludarabine and cyclophosphamide

Leukemia and Lymphoma 44(6): 993-996

Fludarabine is an active agent for the treatment of Waldenstrom's macroglobulinemia (WM) and its combination with cyclophosphamide has been effective in many patients with low-grade lymphoma and chronic lymphocytic leukemia. Based on these data, we administered the combination of fludarabine (25 mg/m2 i.v. day 1-3) and cyclophosphamide (250 mg/m2 i.v. day 1-3,) to 11 patients with WM. Most patients had features indicating poor prognosis including median age of 73 years (range 60-84 years), hemoglobin <100 g/l in 73%, B2-microglobulin >3 mg/l in 64%, symptomatic hyperviscosity in 55% of patients. Only 2 patients were previously untreated, 7 were primary refractory and 2 were relapsing on treatment. The fludarabine-cyclophosphamide combination (FC) was administered every 4 weeks for a total of four courses. Partial response, defined by at least 50% reduction of serum monoclonal protein and of tumor infiltrate at all involved sites was documented in 6 patients (55%) (The median time to response was 4 months). Responding patients demonstrated resolution of disease-related symptoms and correction of anemia. Median time to progression for all patients was 24 months. With a mean follow-up of 28 months, two of six responding patients have progressed so far. The probability of 2-year survival is 70%. This regimen was relatively well tolerated. Complications included neutropenia grade 3 or 4 in 3 patients and thrombocytopenia grade 3 or 4 in 2 patients. There were five infectious episodes including two episodes of neutropenic fever. We conclude that the FC combination appears to be active in patients with WM most of whom were resistant to treatment and had poor prognostic factors. The addition of rituximab to FC requires further investigation.

(PDF emailed within 0-6 h: $19.90)

Accession: 035980646

Download citation: RISBibTeXText

PMID: 12854900

DOI: 10.1080/1042819031000077025

Related references

Rituximab and fludarabine or cyclophosphamide combination treatment for older waldenström macroglobulinemia patients. Turkish Journal of Haematology 30(4): 422-423, 2014

Efficacy and long-term toxicity of the rituximab-fludarabine-cyclophosphamide combination therapy in Waldenstrom's macroglobulinemia. American Journal of Hematology 91(8): 782-786, 2017

Multicenter, randomized comparative trial of fludarabine and the combination of cyclophosphamide-doxorubicin-prednisone in 92 patients with Waldenstrom macroglobulinemia in first relapse or with primary refractory disease. Blood 98(9): 2640-2644, November 1, 2001

Rituximab-induced life-threatening coagulopathy occurring in a patient with Waldenström macroglobulinemia treated with fludarabine, cyclophosphamide, and rituximab combination. Leukemia and Lymphoma 51(12): 2288-2290, 2011

Fludarabine plus cyclophosphamide in Waldenstrom's macroglobulinemia: results in 49 patients. Leukemia 19(10): 1831-1834, 2005

Fludarabine combination therapy is highly effective in first-line and salvage treatment of patients with Waldenström's macroglobulinemia. Clinical Lymphoma and Myeloma 6(2): 136-139, 2005

Fludarabine, cyclophosphamide, and rituximab in salvage therapy of Waldenström's macroglobulinemia. Clinical Lymphoma, Myeloma and Leukemia 13(2): 231-234, 2013

Fludarabine, cyclophosphamide and rituximab (FCR) induced pulmonary hypertension in Waldenstrom macroglobulinemia. Leukemia and Lymphoma 49(6): 1209-1211, 2008

Phase 2 study of ofatumumab, fludarabine and cyclophosphamide in relapsed/refractory Waldenström's macroglobulinemia. Leukemia and Lymphoma 58(6): 1506-1508, 2016

Clinical analysis of dexamethasone and rituximab in combination with cyclophosphamide in the treatment of 18 patients with Waldenström macroglobulinemia. Zhonghua Xue Ye Xue Za Zhi 39(7): 589-592, 2018

Fludarabine-based combination therapies for Waldenström's macroglobulinemia. Clinical Lymphoma and Myeloma 9(1): 67-70, 2009

Fludarabine plus cyclophosphamide and rituximab in Waldenstrom macroglobulinemia: an effective but myelosuppressive regimen to be offered to patients with advanced disease. Cancer 118(2): 434-443, 2012

Fludarabine, cyclophosphamide and rituximab in Waldenstrom's macroglobulinemia: An effective regimen requiring a new category of response criteria and a delayed assessment of results. Blood 110(11, Part 1): 388A, 2007

Cyclophosphamide, bortezomib, and dexamethasone combination in waldenstrom macroglobulinemia. American Journal of Hematology 90(6): E122-E123, 2015

Second treatment with fludarabine in a Waldenström's macroglobulinemia patient. Leukemia 14(1): 220, 2000