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Blood, 16 April 2009, Vol. 113, No. 16, pp. 3673-3678. Prepublished online as a Blood First Edition Paper on November 17, 2008; DOI 10.1182/blood-2008-09-177329. This Article Full Text (PDF) All Versions of this Article: blood-2008-09-177329v1 113/16/3673    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Treon, S. P. Articles by Kimby, E. Search for Related Content PubMed PubMed Citation Articles by Treon, S. P. Articles by Kimby, E. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted September 23, 2008 Accepted October 27, 2008 Long term outcomes to fludarabine and rituximab in Waldenstrom macroglobulinemia Steven P. Treon*, Andrew R Branagan, Leukothea Ioakimidis, Jacob D. Soumerai, Christopher J. Patterson, Barry Turnbull, Parveen Wasi, Christos Emmanouilides, Stanley R. Frankel, Andrew Lister, Pierre Morel, Jeffrey Matous, Stephanie A. Gregory, and Eva Kimby Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States BioBridges LLC, Boston, MA, United States McMaster University Medical Center, Hamilton, Ontario, Canada UCLA Medical Center, Los Angeles, CA, United States Greenebaum Cancer Center, University of Maryland, Baltimore, MD, United States Medical Oncology, St. Bartholomew's Hospital and Cancer Research, London, United Kingdom Clinical Hematology, Centre Hospitalier Schaffner, Lens, France Rocky Mountain Cancer Center, Denver, CO, United States Rush University Medical Center, Chicago, IL, United States Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden * Corresponding author; email: steven_treon{at}dfci.harvard.edu. We report the long term outcome of a multicenter, prospective study examining fludarabine and rituzimab in Waldenstrom macroglobulinemia (WM). WM patients with < 2 prior therapies were eligible. Intended therapy consisted of 6 cycles (25 mg/m2/day for 5 days) of fludarabine and 8 infusions (375 mg/m2/week) of rituximab. 43 patients were enrolled. Responses were: CR (n=2); VGPR (n=14); PR (n=21); MR (n=4); for an overall and major response rate of 95.3% and 86.0%, respectively. At best response, median bone marrow disease involvement declined from 55% to 5% (p<0.00001); serum IgM decreased from 3,840 to 443 mg/dL (p<0.00001); and hematocrit rose from 31.2% to 38.0% (p<0.0008). The median time to progression for all patients was 51.2 months, and was longer for untreated patients (p=0.017), and those achieving >VGPR (p=0.049). Grade > 3 toxicities included neutropenia (n=27); thrombocytopenia (n=7); pneumonia (n=6), including two patients who succumbed to non-PCP interstitial pneumonia. With a median follow-up of 40.3 months, we observed 3 cases of transformation to aggressive lymphoma and 3 cases of MDS/AML. The results of this study demonstrate that fludarabine and rituximab is highly active in WM, though short and long term toxicities need to be carefully weighed against other available treatment options. This study is registered with ClinicalTrials.gov under identifier NCT00020800. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: S. P. Treon How I treat Waldenstrom macroglobulinemia Blood, September 17, 2009; 114(12): 2375 - 2385. [Abstract] [Full Text] [PDF] S. P. Treon, L. Ioakimidis, J. D. Soumerai, C. J. Patterson, P. Sheehy, M. Nelson, M. Willen, J. Matous, J. Mattern II, J. G. Diener, et al. Primary Therapy of Waldenstrom Macroglobulinemia With Bortezomib, Dexamethasone, and Rituximab: WMCTG Clinical Trial 05-180 J. Clin. Oncol., August 10, 2009; 27(23): 3830 - 3835. [Abstract] [Full Text] [PDF]

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