title: Fludarabine, cyclophosphamide, and rituximab in salvage therapy of Waldenström's macroglobulinemia.
abstract: The combination FCR (fludarabine, cyclophosphamide, and rituximab) proved to be active in Waldenström's macroglobulinemia in a mixed population of untreated and previously treated patients. Prolonged myelosuppression and concerns about purine analogue treatment led to the conclusion that this regimen should be avoided in younger patients in first-line treatment. In this retrospective study on 40 patients we observed a response rate of 80% (32) after FCR salvage treatment with 32.5% (13) of patients reaching at least a very good partial remission. None of the prognostic variables had a significant effect on response or good quality of response achievement. Median event-free survival was reached at 77 months; median progression-free survival was not reached after a median follow-up of 51 months with any difference when categorizing patients according to quality of response. The results of this study suggest that the FCR regimen might overcome poor prognostic features and should be taken into account as salvage treatment. Tardive immunosuppression and myelosuppression warrant accurate patient follow-up.
authors.affiliation: Division of Hematology, Ospedale Niguarda Ca' Granda Milano, Milano, Italy. alessandra.tedeschi@ospedaleniguarda.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Tedeschi
authors.forename: Francesca
authors.initials: F
authors.lastname: Ricci
authors.forename: Maria Cecilia
authors.initials: MC
authors.lastname: Goldaniga
authors.forename: Giulia
authors.initials: G
authors.lastname: Benevolo
authors.forename: Marzia
authors.initials: M
authors.lastname: Varettoni
authors.forename: Marina
authors.initials: M
authors.lastname: Motta
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
authors.forename: Guido
authors.initials: G
authors.lastname: Gini
authors.forename: Claudia
authors.initials: C
authors.lastname: Barate'
authors.forename: Annamaria
authors.initials: A
authors.lastname: Luraschi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Vismara
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Frustaci
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy* / Q000401:mortality
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine