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Waldenstrom's

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Should we treat or not???
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<<<<<<<<<>>>>>>>>>
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Unknown Primary
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Oncogenes, the list!
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Mechanism of Action
Dose Modifications (Renal)
Dose Modifications (hepatic)
MDR

1. Chlorambucil +/- prednisone
2. 2CdA
3. Cladribine
4. Fludarabine

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2-chlorodeoxyadenosine

2-chlorodeoxyadenosine 0.1 mg/kg/d for a 7-day continuous infusion, using a portable pump through a central venous catheter


REF:JCO 12:2694-2698,
22/26 responded to the therapy (85%; 95% confidence interval [CI], 65% to 96%), including 3 who achieved a CR & 19 who had a PR. Treatment was well tolerated, with no acute hematologic toxicity
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CLADRIBINE 0.12 mg/kg/d by 2 h intravenous infusion for 5 consecutive days at monthly intervals X 3 courses. Partially responding patients were continued on therapy until maximal response and/or prohibitive toxicity, to a maximum of eight courses.

REF: Br J Haematol 1998 Dec;103(3):690-5
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CLADRIBINE COMBINATIONS
Cladribine 0.1 mg per kg per day SQ on days 1 to 3
Cyclophosphamide 500 mg/m2 IV on day 1
Prednisone 40 mg/m2 PO on days 1 through 5

Preliminary results in patients with low-grade lymphoproliferative diseases have found an overall response rate of 88%, with complete response in 21%. No treatment-related deaths. severe neutropenia noted in 2 patients. Only a small number of patients with WM have been evaluated & no long-term data are available.
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FLUDARABINE

FLUDARABINE 30 mg/m2 IV daily for 5 consecutive days every 4 weeks

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HIGH-DOSE THERAPY with autologous stem-cell rescue is effective in many patients with multiple myeloma and this treatment has also been administered in a small number of patients with WM. Ten of 11 patients treated with high-dose melphalan supported by autologous marrow or blood stem cells achieved a response, including patients with resistance to prior fludarabine treatment

REVIEW ARTICLE:
Journal of Clinical Oncology, Vol 18, Issue 1 (January), 2000: 214

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