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High-dose therapy with autologous PBSC transplantation in the front-line treatment of Waldenstrom's macroglobulinemia

Bone Marrow Transplantation volume 43, pages 587–588 (2009)Cite this article

Waldenstrom's macroglobulinemia (WM) is an incurable and rare B-cell lymphoproliferative disorder characterized by BM infiltration of lymphoplasmacytic cells and production of monoclonal immunoglobulin M. Prognostic factors include patient’s age, β2-microglobulin level, monoclonal protein level, hemoglobin concentration and platelet count.1 Therapy is generally reserved for symptomatic patients; however, no demonstration of chemotherapeutic agent or regimen superiority, including autograft, has been reported.2 We have evaluated the efficacy and feasibility of a therapeutic strategy including high-dose therapy (HDT), anti-CD20 MoAb (rituximab) and autologous PBSC transplant (PBSCT) in upfront patients with WM.

Between April 2001 and October 2003, five male patients with symptomatic WM, who signed informed consent, were enrolled in an open-label trial of HDT (CHOP three courses, rituximab four weekly infusions at 375 mg/m2, CY at 4 g/m2+G-CSF) followed by PBSCT, conditioned with melphalan at 200 mg/m2. Main pretreatment characteristics were the following: median age 53.5 years (range, 41–66); median β2M 3.86 mg/l (range, 0.6–6.6); median hemoglobin 9.65 g/100 ml (range, 7.3–12.9); median platelets 215 × 109/l (range, 90–383 × 109); median serum monoclonal component 3.2 g/100 ml (range, 1.0–6.4); median BM lymphoplasmacytic infiltration 55% (range, 30–80). Three patients were hepatitis C virus (HCV) positive. The European Group for Blood and Marrow Transplantation (EBMT)/International Bone Marrow Transplant Registry (IBMTR)/Autologous Blood and Marrow Transplant Registry (ABMTR) criteria were used for definition of response;3 toxicity was graded according to the WHO criteria.

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Authors and Affiliations

  1. Department of Haematology, St Eugenio Hospital, University Tor Vergata, Rome, Italy

    T Caravita, A Siniscalchi, A Tendas, L Cupelli, T Dentamaro, G Natale, A Spagnoli & P de Fabritiis

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  1. T Caravita
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  2. A Siniscalchi
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  3. A Tendas
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  4. L Cupelli
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Correspondence to T Caravita.

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Caravita, T., Siniscalchi, A., Tendas, A. et al. High-dose therapy with autologous PBSC transplantation in the front-line treatment of Waldenstrom's macroglobulinemia. Bone Marrow Transplant 43, 587–588 (2009). https://doi.org/10.1038/bmt.2008.360

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