Originally published as JCO Early Release 10.1200/JCO.2007.10.9926 on June 18 2007

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dimopoulos, M. A. Articles by Pangalis, G. Search for Related Content PubMed PubMed Citation Articles by Dimopoulos, M. A. Articles by Pangalis, G. Social Bookmarking                            What's this?

Primary Treatment of Waldenström Macroglobulinemia With Dexamethasone, Rituximab, and Cyclophosphamide

Meletios Athanasios Dimopoulos, Athanasios Anagnostopoulos, Marie-Christine Kyrtsonis, Konstantinos Zervas, Constantinos Tsatalas, Garyfallia Kokkinis, Panagiotis Repoussis, Argyris Symeonidis, Souzana Delimpasi, Eirini Katodritou, Elina Vervessou, Evridiki Michali, Anastasia Pouli, Dimitra Gika, Amalia Vassou, Evangelos Terpos, Nikolaos Anagnostopoulos, Theophanis Economopoulos, Gerasimos Pangalis

From the Departments of Clinical Therapeutics, Internal Medicine, and the Second Department of Propedeutic Medicine, University of Athens School of Medicine; Department of Hematology, Sismanoglion Hospital; Department of Hematology, Metaxa Hospital; Department of Hematology, Evangelismos Hospital; Department of Hematology, Erikos Dynan Hospital; Department of Hematology, Genimata General Hospital; Department of Hematology, General Airforce Hospital, Athens; Department of Hematology, Theagenion Cancer Center, Thessaloniki; Department of Hematology, University of Alexandroupolis; Department of Hematology, University of Patras; Department of Hematology, Agios Savvas Cancer Center; and the Department of Hematology, University of Ioannina, Greece

Address reprint requests to Meletios A. Dimopoulos, MD, Department of Clinical Therapeutics, Alexandra Hospital, 80 Vass Sofias, Athens 11528, Greece; e-mail: meldimop{at}hotmail.com

Purpose Alkylating agents and the anti-CD20 monoclonal antibody rituximab are among appropriate choices for the primary treatment of symptomatic patients with Waldenström 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/m² 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 beta₂-microglobulin (43%).

Results On an intent-to-treat basis, 83% of patients (95% CI, 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.

published online ahead of print at www.jco.org on June 18, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. P. Treon How I treat Waldenstrom macroglobulinemia Blood, September 17, 2009; 114(12): 2375 - 2385. [Abstract] [Full Text] [PDF]

				S. P. Treon, L. Ioakimidis, J. D. Soumerai, C. J. Patterson, P. Sheehy, M. Nelson, M. Willen, J. Matous, J. Mattern II, J. G. Diener, et al. Primary Therapy of Waldenstrom Macroglobulinemia With Bortezomib, Dexamethasone, and Rituximab: WMCTG Clinical Trial 05-180 J. Clin. Oncol., August 10, 2009; 27(23): 3830 - 3835. [Abstract] [Full Text] [PDF]

				P. Morel, A. Duhamel, P. Gobbi, M. A. Dimopoulos, M. V. Dhodapkar, J. McCoy, J. Crowley, E. M. Ocio, R. Garcia-Sanz, S. P. Treon, et al. International prognostic scoring system for Waldenstrom macroglobulinemia Blood, April 30, 2009; 113(18): 4163 - 4170. [Abstract] [Full Text] [PDF]

				M. A. Dimopoulos, M. A. Gertz, E. Kastritis, R. Garcia-Sanz, E. K. Kimby, V. LeBlond, J.-P. Fermand, G. Merlini, P. Morel, E. Morra, et al. Update on Treatment Recommendations From the Fourth International Workshop on Waldenstrom's Macroglobulinemia J. Clin. Oncol., January 1, 2009; 27(1): 120 - 126. [Abstract] [Full Text] [PDF]

				S. P. Treon, J. D. Soumerai, A. R. Branagan, Z. R. Hunter, C. J. Patterson, L. Ioakimidis, F. M. Briccetti, M. Pasmantier, H. Zimbler, R. B. Cooper, et al. Thalidomide and rituximab in Waldenstrom macroglobulinemia Blood, December 1, 2008; 112(12): 4452 - 4457. [Abstract] [Full Text] [PDF]

				M. A. Dimopoulos, E. Kastritis, S. Delimpassi, A. Zomas, M. C. Kyrtsonis, and K. Zervas The International Prognostic Scoring System for Waldenstrom's macroglobulinemia is applicable in patients treated with rituximab-based regimens Haematologica, September 1, 2008; 93(9): 1420 - 1422. [Full Text] [PDF]