In patients with Waldenstrom's macroglobulinaemia treated with fludarabine or CAP there may not be statistical difference in overall survival rate, but fludarabine may to be superior in terms of response rate and duration.
A Cochrane review 1 included 1 study with a total of 92 subjects. The effect of fludarabine was compared to the combination of cyclophosphamide (the alkylating agent), doxorubicin and prednisone (CAP) in patients with pretreated/relapsed WM. Compared to CAP, the Hazard ratio (HR) for deaths of treatment with fludarabine was estimated to be 1.04, with a standard error of 0.30 (95% CI 0.58 to 1.48) The mean difference of median survival time was -4.00 months, and 16.00 months for response duration in favour of fludarabine. The relative risks (RR) of response rate was 2.80 (95% CI 1.10 to 7.12).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals).
1. Yang K, Tan J, Wu T. Alkylating agents for Waldenstrom's macroglobulinaemia. Cochrane Database Syst Rev 2009 Jan 21;(1):CD006719. [PMID:19160296]
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"Alkylating Agents and Fludarabine for Waldenstrom's Macroglobulinaemia." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/451926/all/Alkylating_agents_and_fludarabine_for_Waldenstrom's_macroglobulinaemia.
Alkylating agents and fludarabine for Waldenstrom's macroglobulinaemia. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/451926/all/Alkylating_agents_and_fludarabine_for_Waldenstrom's_macroglobulinaemia. Accessed April 6, 2020.
Alkylating agents and fludarabine for Waldenstrom's macroglobulinaemia. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved April 06, 2020, from https://evidence.unboundmedicine.com/evidence/view/EBMG/451926/all/Alkylating_agents_and_fludarabine_for_Waldenstrom's_macroglobulinaemia
Alkylating Agents and Fludarabine for Waldenstrom's Macroglobulinaemia [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 April 06]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/451926/all/Alkylating_agents_and_fludarabine_for_Waldenstrom's_macroglobulinaemia.
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