Journal of Clinical Oncology, Vol 12, 2694-2698, Copyright © 1994 by American Society of Clinical Oncology

ARTICLES

Primary therapy of Waldenstrom's macroglobulinemia with 2- chlorodeoxyadenosine

MA Dimopoulos, H Kantarjian, D Weber, S O'Brien, E Estey, K Delasalle, E Rose, F Cabanillas, M Keating and R Alexanian
Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston.

PURPOSE: To assess the activity of 2-chlorodeoxyadenosine (2CdA) as primary therapy for patients with Waldenstrom's macroglobulinemia. PATIENTS AND METHODS: 2CdA was given to 26 consecutive, previously untreated and symptomatic patients with Waldenstrom's macroglobulinemia. Two courses were administered to outpatients at a dose of 0.1 mg/kg body weight per day for a 7-day continuous infusion using a portable pump through a central venous catheter. Responding patients were followed up without further therapy and were scheduled to receive two additional treatments with 2CdA on disease relapse. RESULTS: Twenty-two of 26 patients responded to the 2CdA therapy (85%; 95% confidence interval [CI], 65% to 96%), including three patients who achieved a complete response and 19 patients who had a partial response. Treatment was well tolerated, with no acute hematologic toxicity. A marked and sustained reduction of CD4+ lymphocytes occurred in all patients and may have contributed to a fatal infection with disseminated herpes simplex in one patient. With a median follow-up of 13 months, five patients have relapsed and all re-treated patients have responded again to 2CdA. CONCLUSION: 2CdA is highly active in previously untreated patients with Waldenstrom's macroglobulinemia. A limited program of treatment induced responses of good quality and long duration in more than 80% of patients.
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