Cladribine for Waldenström's macroglobulinaemia

Delannoy, André; Neste, Éric Van Den; Michaux, Jl.; Bosly, André; Ferrant, Augustin

doi:10.1046/j.1365-2141.1999.1331f.x

Cited by 31 publications

(15 citation statements)

References 5 publications

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“…This patient did not receive prophylaxis against Pneumocystis. Dimopoulos et al (1995) Continuous infusion 2 46 46/0 6 37 43 Dimopoulos et al (1994b) Continuous infusion 2 14 14*/0 0 28 28 Delannoy et al (1994) Continuous infusion 2 18 13/5 0 39 39 * All fludarabine-failed (primary resistant disease or relapsed).…”

Section: Survivalmentioning

confidence: 99%

Bolus administration of cladribine in the treatment of Waldenström macroglobulinaemia

et al. 1998

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Summary. This phase II clinical trial evaluated bolus cladribine as a single agent in Waldenström macroglobulinaemia (WM).Cladribine was administered to 20 patients at a dose of 0·12 mg/kg/d by 2 h intravenous infusion for 5 consecutive days at monthly intervals for three courses. Partially responding patients were continued on therapy until maximal response and/or prohibitive toxicity, to a maximum of eight courses. Complete responders were treated with one additional course of cladribine.After a median of three courses of cladribine, all 20 patients were evaluable; one achieved a complete response (CR) (5%) and 10 achieved a partial response (PR) (50%). The median duration of response follow-up was 28 months (range 1-37 months). Four of 7 (57%) untreated and 7/13 (54%) previously treated patients responded. The major toxicity encountered was myelosuppression with 60% of patients demonstrating grade 3 or 4 neutropenia. Nonhaematological toxicities included two patients with herpes zoster and two patients with non-melanoma skin cancers. At a median follow-up duration of 20 months, 17 patients remain alive and three have died.We confirm that bolus cladribine is an effective and safe method of drug delivery in WM patients. Recommendations regarding the equivalence of the continuous infusion and bolus methods in untreated patients requires further study. Bolus cladribine is more convenient and less costly than infusional cladribine since it obviates the need for central catheters and infusional devices.

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Section: Survivalmentioning

confidence: 99%

Bolus administration of cladribine in the treatment of Waldenström macroglobulinaemia

et al. 1998

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“…In this disease 2-CdA has been shown to be active in 64% to 100% of previously untreated patients and in 14% to 78% of refractory or relapsed patients [74][75][76][77][78][79][80][81]. The number of cycles administered in these studies varied considerably but significant tumor reduction was observed as early as after two courses of 2-CdA.…”

Section: Waldenström's Macroglobulinemiamentioning

confidence: 95%

Recent Clinical Trials of Cladribine in Hematological Malignancies and Autoimmune Disorders

Robak

Wierzbowska²,

Robak

2006

RRCT

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The purine nucleoside analog - cladribine (2-chlorodeoxyadenosine, 2-CdA) is a cytotoxic agent with high activity in lymphoid and myeloid malignancies. It is also an effective drug in some autoimmune disorders. 2-CdA is usually administered intravenously in continuous or 2-hour infusion. Recently however, new formulation of this agent has been developed for subcutaneous and oral administration. 2-CdA is widely established as first line standard treatment for hairy cell leukemia. Moreover several clinical trials have demonstrated that this agent, used alone or in combination with other cytotoxic drugs, showed good efficacy and acceptable toxicity profile in the treatment of chronic lymphocytic leukemia, Waldenström macroglobulinemia, low-grade non-Hodgkin's lymphoma and acute myeloid leukemia. Moreover, some studies indicate that 2-CdA has some activity in progressive multiple sclerosis and other autoimmune disorders including autoimmune hemolytic anemia, rheumatoid arthritis, systemic lupus erythematosus, psoriasis and in patients with refractory factor VIII inhibitors. This review article will summarize the results of recent clinical trials with 2-CdA in hematological malignancies, multiple sclerosis and other autoimmune diseases.

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“…Several phase II studies with a relatively small number of patients have evaluated the role of cladribine as primary treatment in WM. At least a partial response was documented in 64-90% of patients [9][10][11]. The number of cycles of cladribine administered in these trials varied considerably, but objective responses have been documented even with only two cycles of treatment.…”

Section: Nucleoside Analogues-based Chemotherapymentioning

confidence: 95%

Treatment of Waldenstrom’s Macroglobulinemia

Dimopoulos

Anagnostopoulos

2007

Curr. Treat. Options in Oncol.

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Waldenstrom's macroglobulinemia is defined by bone marrow lymphoplasmacytic infiltration and by production of monoclonal IgM. Treatment is employed only to symptomatic patients. Alkylating agents (chlorambucil), nucleoside analogues and rituximab are reasonable choices for primary therapy. Combination therapy either with nucleoside analogues with alkylating agents and/or rituximab or rituximab with chemotherapy such as CHOP or cyclophosphamide are also reasonable frontline treatment options for WM patients. Several factors should be taken into account when choosing the most appropriate primary treatment. These factors include the age of the patient and possible co-morbidities, the presence of cytopenias and especially thrombocytopenia, the presence of symptoms and signs indicative of hyperviscosity, the need for rapid disease control due to severe symptoms, significant splenomegaly or lymphadenopathy, symptomatic peripheral neuropathy and whether the patient is candidate for autologous stem cell transplantation. For patients with refractory or relapsing disease, the use of an alternate first-line agent is reasonable. Outside the setting of a clinical trial, the administration of high-dose therapy should be reserved only for patients refractory to alkylating agents, purine nucleoside and rituximab. For patients who develop resistance to all three classes of agents, alemtuzumab, thalidomide with or without dexamethasone or bortezomib could be tried.

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Cladribine for Waldenström's macroglobulinaemia

Cited by 31 publications

References 5 publications

Bolus administration of cladribine in the treatment of Waldenström macroglobulinaemia

Bolus administration of cladribine in the treatment of Waldenström macroglobulinaemia

Recent Clinical Trials of Cladribine in Hematological Malignancies and Autoimmune Disorders

Treatment of Waldenstrom’s Macroglobulinemia

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