Division of Hematology, Ospedale Niguarda Ca' Granda Milano, Milano, Italy.
Clin Lymphoma Myeloma Leuk. 2013 Apr;13(2):231-4. doi: 10.1016/j.clml.2013.02.011. Epub 2013 Mar 13.
The combination FCR (fludarabine, cyclophosphamide, and rituximab) proved to be active in Waldenström's macroglobulinemia in a mixed population of untreated and previously treated patients. Prolonged myelosuppression and concerns about purine analogue treatment led to the conclusion that this regimen should be avoided in younger patients in first-line treatment. In this retrospective study on 40 patients we observed a response rate of 80% (32) after FCR salvage treatment with 32.5% (13) of patients reaching at least a very good partial remission. None of the prognostic variables had a significant effect on response or good quality of response achievement. Median event-free survival was reached at 77 months; median progression-free survival was not reached after a median follow-up of 51 months with any difference when categorizing patients according to quality of response. The results of this study suggest that the FCR regimen might overcome poor prognostic features and should be taken into account as salvage treatment. Tardive immunosuppression and myelosuppression warrant accurate patient follow-up.
FCR（氟达拉滨、环磷酰胺和利妥昔单抗）联合方案在未经治疗和既往治疗的混合人群中，对 Waldenström 巨球蛋白血症表现出了疗效。由于担心嘌呤类似物治疗会导致骨髓抑制时间延长，该方案被认为不适合用于一线治疗的年轻患者。在这项针对 40 名患者的回顾性研究中，我们观察到 FCR 挽救治疗的缓解率为 80%（32 例），其中 32.5%（13 例）的患者达到了至少非常好的部分缓解。没有任何预后变量对缓解或获得良好缓解质量有显著影响。中位无事件生存时间达到 77 个月；中位随访 51 个月后，无进展生存尚未达到，根据缓解质量对患者进行分类时，没有差异。这项研究的结果表明，FCR 方案可能克服了不良预后特征，应作为挽救治疗方案加以考虑。延迟的免疫抑制和骨髓抑制需要对患者进行准确的随访。
