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Fludarabine in Waldenstrom's macroglobulinemia.
[waldenström macroglobulinemia]
Waldenstrom
's
macroglobulinemia
is
a
rare
chronic
lymphoproliferative
disorder
.
Treatment
is
usually
based
on
nucleoside
analogues
,
alkylators
,
bortezomib
and
monoclonal
antibodies
,
alone
or
in
combination
.
Fludarabine
is
a
fluorinated
purine
analogue
effective
in
chronic
lymphoproliferative
disorders
.
In
Waldenstrom
's
macroglobulinemia
,
fludarabine
was
first
studied
in
patients
with
relapsed
or
refractory
disease
after
alkylator
therapy
,
yielding
an
overall
response
rate
of
30
%
.
In
the
late
1990
s
,
fludarabine
started
to
be
used
as
a
first
-line
treatment
monotherapy
yielding
response
rates
between
36
and
94
%
.
A
recent
Phase
III
trial
showed
that
fludarabine
monotherapy
was
more
effective
than
chlorambucil
in
terms
of
progression-free
survival
,
duration
of
response
and
overall
survival
.
Fludarabine
has
also
been
studied
in
combination
with
rituximab
and
/
or
alkylating
agents
,
leading
to
better-quality
and
longer
lasting
responses
.
Hematological
toxicity
is
a
major
concern
;
however
,
restricting
first
-line
use
of
fludarabine
in
patients
who
do
not
qualify
for
autologous
stem
cell
transplantation
,
require
rapid
disease
control
or
have
factors
of
poor
prognosis
.
Diseases
Validation
Diseases presenting
"better-quality"
symptom
waldenström macroglobulinemia
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