title: IFN-alpha as induction and maintenance treatment of patients newly diagnosed with Waldenström's macroglobulinemia.
abstract: Waldenström's macroglobulinemia is a rare malignant disorder of B lymphocytes. There are no studies on the use of interferon-alpha (IFN-alpha) as frontline therapy in this disease. Between April 1991 and September 2000, we treated 21 newly diagnosed patients using 8 mg/m(2) chlorambucil and 40 mg/m(2) prednisone p.o. daily for 10 days and 3 megaU/m(2) IFN-alpha three times a week. Patients who responded after induction continued receiving IFN until relapse or death. We found a high frequency of peripheral neuropathy (43%) and grade 3 diffuse marrow fibrosis (43%). Objective response was achieved in 12 (57%) patients, including 4 (19%) complete responders. Median time from treatment to response was 8 months (range 3-18). Median progression-free survival was 70 months (95% CI 47-93), and overall survival was 91 months (95% CI 50-132). Patients who achieved objective response lived longer (91 vs. 33 months, p < 0.03), as did patients who had lactic dehydrogenase (LDH) < 180 U/L (89 vs. 54 months, p < 0.01). Grade 3 hematologic toxicity was observed during induction in 5 patients. IFN-alpha is an effective agent for the induction and maintenance treatment of Waldenström's macroglobulinemia patients. LDH > 180 U/L and failure to respond are adverse prognostic factors.
authors.affiliation: Department of Hematology, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, México DF, México. velaj12x@prodigy.net.mx
authors.forename: J
authors.initials: J
authors.lastname: Vela-Ojeda
authors.forename: M A
authors.initials: MA
authors.lastname: García-Ruiz Esparza
authors.forename: Y
authors.initials: Y
authors.lastname: Padilla-González
authors.forename: A
authors.initials: A
authors.lastname: Rosas-Cabral
authors.forename: J
authors.initials: J
authors.lastname: García-Chávez
authors.forename: M
authors.initials: M
authors.lastname: Xolotl-Castillo
authors.forename: D
authors.initials: D
authors.lastname: Salazar-Exaire
authors.forename: J
authors.initials: J
authors.lastname: Arenas-Osuna
authors.forename: J A
authors.initials: JA
authors.lastname: Aviña-Zubieta
authors.forename: M
authors.initials: M
authors.lastname: Vadillo-Buenfil
authors.forename: S
authors.initials: S
authors.lastname: Abraham-Majluf
mesh_terms: D000368:Aged; D002699:Chlorambucil / Q000008:administration & dosage / Q000627:therapeutic use; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008297:Male; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012074:Remission Induction; D013997:Time Factors; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D016898:Interferon-alpha; D011994:Recombinant Proteins; D002699:Chlorambucil; D007770:L-Lactate Dehydrogenase; D011241:Prednisone