Chlorambucil or Fludarabine as First-Line Therapy in Treating Patients With Previously Untreated Waldenström Macroglobulinemia, Splenic Lymphoma, or Lymphoplasmacytic Lymphoma

This is an interventional treatment trial for Lymphoma focused on measuring Waldenström macroglobulinemia, splenic marginal zone lymphoma, stage I marginal zone lymphoma, stage III marginal zone lymphoma, stage IV marginal zone lymphoma, contiguous stage II marginal zone lymphoma, noncontiguous stage II marginal zone lymphoma Read More

DISEASE CHARACTERISTICS:

• Diagnosis of Waldenström macroglobulinemia, splenic lymphoma with villous lymphocytes (SLVL), or non-IgM lymphoplasmacytic lymphoma based on morphological and immunophenotypic criteria

  • Bone marrow should be assessed by two-color flow cytometry for the expression of the following antigens:

    • Surface Ig
    • CD19
    • CD20
    • CD5
    • CD10
    • CD23

• Previously untreated disease requiring therapeutic intervention (as judged by the primary physician), as indicated by ≥ 1 of the following:

  • Hemoglobin < 10 g/dL
  • ANC < 1.5 x 10^9/L
  • Platelet count < 150 x 10^9/L
  • Clinical evidence of hyperviscosity in terms of neurological or ocular disturbance
• Patients with disease detected by clonal cells alone are not eligible

PATIENT CHARACTERISTICS:

• Performance status 0-2
• Life expectancy > 6 months
• Serum creatinine < 200 mmol/L
• AST and ALT < 2 times upper limit of normal
• Negative direct Coomb's test
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for ≥ 6 months after completion of study therapy
• No severe or life-threatening cardiac, pulmonary, neurological, psychiatric, or metabolic disease
• No other concurrent malignancy
• No AIDS or AIDS-related complex
• No evidence of active hepatitis C infection

PRIOR CONCURRENT THERAPY:

• Prior plasmapheresis for control of clinically significant hyperviscosity allowed
• Prior splenectomy for SLVL allowed