Regimen Beneficial for Waldenstrom Macroglobulinemia

Complete or very good partial remission with fludarabine, cyclophosphamide, rituximab regimen

FRIDAY, July 15 (HealthDay News) -- Treatment with fludarabine, cyclophosphamide, and rituximab (FCR), in patients with Waldenstrom macroglobulinemia (WM), shows high complete remissions (CRs) and very good partial remission (VGPR) rates, according to a study published online July 5 in Cancer.

Alessandra Tedeschi, M.D., from the Niguarda Ca' Granda Hospital in Milan, Italy, and colleagues investigated the efficacy of an FCR regimen in 43 patients with symptomatic WM, previously untreated or pretreated with one line of chemotherapy. Patients received intravenous rituximab 375 mg/m² on day one and intravenous fludarabine 25 mg/m² and cyclophosphamide 250 mg/m² through days two and four. All participants received up to six courses of FCR, repeated every 28 days.

The investigators identified 11.6 percent CRs and 20.9 percent VGPR, with overall and major response rates of 79 and 74.4 percent, respectively. The quality of responses improved during follow-up with 18.6 percent CRs. No difference in responses was seen in patients who had previously been treated or untreated. Among clinical and laboratory features analyzed, a significant impact in terms of achieving major responses was observed only for β 2-microglobulin level. Grade 3/4 neutropenia was the major toxicity reported in 45 percent of FCR courses, and it was also the main reason for treatment discontinuation. Long-lasting episodes of neutropenia were seen in 19 patients (44 percent) at the end of treatment, while three patients developed myelodysplastic syndrome during follow-up.

"FCR produces rapid responses with high rates of CR and VGPR in patients with WM," the authors write. "By modulating doses and therapy duration, FCR may be considered an effective salvage regimen capable of neutralizing adverse prognostic factors in patients with WM."

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