title: Activity of fludarabine in previously treated Waldenström's macroglobulinemia: a report of 71 cases. Groupe Coopératif Macroglobulinémie.
abstract: OBJECTIVE
  There is no consensus on the treatment of patients with Waldenström's macroglobulinemia (WM) who develop primary or secondary resistance to frontline therapies. We report our experience on the activity and toxicity of fludarabine in 71 patients with WM resistant to prior chemotherapy regimens.
  
  
  METHODS
  From January 1991 to June 1995, 71 patients were included in this retrospective study. The median age, median time from diagnosis to treatment, median immunoglobulin M (IgM) level, and median number of previous treatments were 68 years (range, 42 to 81), 5.9 years (range, 0.6 to 20), 35 g/L (range, 5 to 126), and two (range, one to four), respectively.
  
  
  RESULTS
  Seventy-one patients received a median of six courses of fludarabine. Twenty-one (30%) responded with a partial response and 50 (70%) were considered as treatment failures. Forty-six patients died: 10 in the responder group and 36 in the failure group. Twenty-five patients were alive with a median follow-up time of 34 months. The overall median survival time of all treated patients was 23 months. The time to treatment failure was 32 months. The only factor that favorably influenced the response to fludarabine was a longer interval between the first treatment and the start of fludarabine. Pretreatment factors associated with shorter survival in the entire population were hemoglobin level less than 95 g/L (P = .02) and platelet count less than 75 x 10(9)/L (P = .02).
  
  
  CONCLUSIONS
  The responses rate in this population with a poor prognosis is close to that reported in shorter series. Patients with WM who are resistant to alkylating agents should be identified early, so that salvage therapy with nucleoside analogs can be started without delay.
authors.affiliation: Département d'hématologie, Hôpital Pitié-Salpétrière, Paris, France. veronique.leblond@pse.ap-lop-paris.fr
authors.forename: V
authors.initials: V
authors.lastname: Leblond
authors.forename: T
authors.initials: T
authors.lastname: Ben-Othman
authors.forename: E
authors.initials: E
authors.lastname: Deconinck
authors.forename: A L
authors.initials: AL
authors.lastname: Taksin
authors.forename: J L
authors.initials: JL
authors.lastname: Harousseau
authors.forename: M A
authors.initials: MA
authors.lastname: Delgado
authors.forename: A
authors.initials: A
authors.lastname: Delmer
authors.forename: F
authors.initials: F
authors.lastname: Maloisel
authors.forename: X
authors.initials: X
authors.lastname: Mariette
authors.forename: P
authors.initials: P
authors.lastname: Morel
authors.forename: J P
authors.initials: JP
authors.lastname: Clauvel
authors.forename: P
authors.initials: P
authors.lastname: Duboisset
authors.forename: S
authors.initials: S
authors.lastname: Entezam
authors.forename: O
authors.initials: O
authors.lastname: Hermine
authors.forename: M
authors.initials: M
authors.lastname: Merlet
authors.forename: I
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: O
authors.initials: O
authors.lastname: Guibon
authors.forename: H
authors.initials: H
authors.lastname: Caspard
authors.forename: N
authors.initials: N
authors.lastname: Fort
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001772:Blood Cell Count; D004351:Drug Resistance; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality
chemical_list: D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D014740:Vidarabine; C024352:fludarabine