title: Transformation and progression of Waldenström's macroglobulinemia following cladribine therapy in two cases: natural evolution or iatrogenic causation?
abstract: We report two cases of Waldenström's macroglobulinemia with an unusual aggressive transformation following treatment with cladribine (2-chlorodeoxyadenosine, 2-CdA), a purine analogue. The first patient developed transformation to a diffuse large-cell non-Hodgkin lymphoma, while the second developed extensive extramedullary involvement. Both patients displayed rapid progression following transformation and were refractory to chemotherapy. Both patients were pretreated with multiple courses of prednisone and chlorambucil, and transformation occurred shortly after therapy with cladribine. We propose that immune suppression from alkylating agents and purine analogues may have contributed to the unusual progression, resulting in a dismal outcome.
authors.affiliation: Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ling
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Joshua
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.forename: Graham
authors.initials: G
authors.lastname: Young
authors.forename: Harry
authors.initials: H
authors.lastname: Iland
authors.forename: Geoff
authors.initials: G
authors.lastname: Watson
authors.forename: P Joy
authors.initials: PJ
authors.lastname: Ho
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D002471:Cell Transformation, Neoplastic / Q000139:chemically induced* / Q000473:pathology; D017338:Cladribine / Q000009:adverse effects*; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016403:Lymphoma, Large B-Cell, Diffuse / Q000139:chemically induced; D008297:Male; D011684:Purine Nucleosides / Q000009:adverse effects / Q000627:therapeutic use; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D011684:Purine Nucleosides; D017338:Cladribine