7 research outputs found
Prognostication in young and old patients with Waldenström’s macroglobulinemia: importance of the International Prognostic Scoring System and of serum lactate dehydrogenase
We analyzed 232 patients with previously untreated, symptomatic WM, of whom 10% were 50 years of age and 21% were > 75 years of age. Disease features and response to treatment were similar among age groups. Patients > 75 years of age had significantly shorter survival (OS; 53 months vs. 113 months for those > 50-75 years vs. not reached for patients 50 years of age; P < .001). Despite the fact that 33% of elderly patients died of causes unrelated to WM, disease-specific survival (DSS) was 72 months for patients > 75 years, 120 months for those > 50-75 years and not reached for patients 50 years (P = .001). International Prognostic Scoring System for WM (IPSSWM) could discriminate 3 risk groups with significantly different OS or DSS. The addition of elevated serum lactate dehydrogenase in the IPSS improved the ability of IPSS to identify a group of patients with a significantly worse outcome (median survival, 55 months)
Primary treatment of Waldenstrom macroglobulinemia with dexamethasone, rituximab, and cyclophosphamide
Purpose
Alkylating agents and the anti-CD20 monoclonal antibody rituximab are
among appropriate choices for the primary treatment of symptomatic
patients with Waldenstrom macroglobulinemia ( WM), and they induce at
least a partial response in 30% to 50% of patients. To improve these
results, we designed a phase II study that included previously untreated
symptomatic patients with WM who received a combination of
dexamethasone, rituximab, and cyclophosphamide ( DRC).
Patients and Methods
Seventy-two patients were treated with dexamethasone 20 mg intravenously
followed by rituximab 375 mg/ m(2) intravenously on day 1 and
cyclophosphamide 100 mg/ m2 orally bid on days 1 to 5 ( total dose,
1,000 mg/ m2). This regimen was repeated every 21 days for 6 months.
Patients’ median age was 69 years and many had features of advanced
disease such as anemia ( 57%), hypoalbuminemia ( 40%), and elevated
serum beta(2)-microglobulin ( 43%).
Results
On an intent-to-treat basis, 83% of patients ( 95% Cl, 73% to 91%)
achieved a response, including 7% complete, 67% partial, and 9% minor
responses. The median time to response was 4.1 months. The 2-year
progression-free survival rate for all patients was 67%; for patients
who responded to DRC, it was 80%. The 2-year disease-specific survival
rate was 90%. Treatment with DRC was well tolerated, with 9% of
patients experiencing grade 3 or 4 neutropenia and approximately 20% of
patients experiencing some form of toxicity related to rituximab.
Conclusion
Our large, multicenter trial showed that the non -stem-cell toxic DRC
regimen is an active, well-tolerated treatment for symptomatic patients
with WM