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Second treatment with fludarabine in a Waldenström's macroglobulinemia patient

Leukemia volume 14, page 220 (2000)Cite this article

Waldenström's macroglobulinemia (WM) is a generalized chronic lymphoproliferative disorder characterized by the production of a monoclonal immunoglobulin M (IgM) by well-differentiated plasmacytic lymphocytes.1 The standard therapy of WM is based on alkylating agents, with or without glucocorticoids. These treatments induce a response in about half of previously untreated patients, with a median survival time of approximately 5 years.23 Few reports are available on the treatment of patients who develop primary or secondary resistance to first-line therapies. In this context, our group demonstrated that fludarabine induced a 30% objective response rate despite intensive previous treatment in most cases. The overall median survival time and the time to treatment failure were 23 months and 32 months, respectively.4 To date, the issue of how to treat patients relapsing after fludarabine has not been adequately addressed. We reported a clinical observation of retreatment by fludarabine at the relapse time.

A 37-year-old man was diagnosed with WM following investigation of anemia in July 1994. He was anemic with adenopathy and hepatosplenomegaly involvement, IgM was 73 g/l. He received three courses of CVP regimen and attained a PR with infectious complication. Then, chlorambucil therapy was given at 6 mg per day for 18 months with a plateau level of IgM at 20 g/l. Eighty months after the begining of chlorambucil, IgM raised to 36 g/l without adenopathy or spleen involvement. He began fludarabine infusion at the dose of 25 mg/m2/day × 5 days, every 4 weeks, associated with acyclovir and pentacarinate to prevent opportunistic infection. Prior to beginning fludarabine his absolute CD4+ and CD8+ lymphocyte counts were 190/μl and 475/μl, respectively. After six cycles, a PR was noted on IgM decreased to 12 g/l and bone marrow had only minimal lymphoplasmocytoid infiltrate. At the same time, absolute CD4+ lymphocyte was 38/μl. Eight months after the completion of fludarabine, the absolute CD4+ lymphocyte was 173/μl without complication and remained stable at 166/μl 17 months after the end of fludarabine regimen. Twenty-two months after first line of fludarabine, recurrence occurred with an increase of IgM level to 35 g/l and adenopathy involvement. His absolute CD4+ and CD8+ lymphocyte counts were 245/μl and 395/μl, respectively. A second line of fludarabine began at the 25 mg/m2/day × 5 days every month. Six cycles were done without complication and induced a PR. At the completion of the treatment, the absolute lymphocyte count was 720/μl with 172/μl CD4+ and 200/μl CD8+. The patient remained in PR 8 months later without any infectious complication.

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  1. Department of Onco-Haematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    F Maloisel, F CAmpos, C Giron & P Dufour

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Maloisel, F., CAmpos, F., Giron, C. et al. Second treatment with fludarabine in a Waldenström's macroglobulinemia patient. Leukemia 14, 220 (2000). https://doi.org/10.1038/sj.leu.2401625

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