{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:39:24Z","timestamp":1791257964080,"version":"4.1.0"},"reference-count":35,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2013,1,20]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Treatment options for patients with Waldenstr\u00f6m macroglobulinemia (WM) and closely related disorders include alkylating agents, purine analogs, and monoclonal antibodies. No large randomized studies have yet been reported comparing any of these approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>The randomized WM1 study (Trial Comparing Chlorambucil to Fludarabine in Patients With Advanced Waldenstr\u00f6m Macroglobulinemia) was undertaken in 101 centers in five countries enrolling 414 eligible patients (339 with WM, 37 with non\u2013mucosa-associated lymphoid tissue marginal zone lymphoma, and 38 with lymphoplasmacytic lymphoma) who were randomly assigned to receive chlorambucil or fludarabine. The primary end point was the overall response rate (ORR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On the basis of intent-to-treat analysis, the ORR was 47.8% (95% CI, 40.9% to 54.8%) in the fludarabine arm versus 38.6% (95% CI, 32.0% to 45.7%) in the chlorambucil arm (P = .07). With a median follow-up of 36 months (interquartile range, 18 to 58 months), median progression-free survival (PFS), and duration of response (DR) were significantly improved in the fludarabine arm compared with the chlorambucil arm: PFS, 36.3 versus 27.1 months (P = .012) and DR, 38.3 versus 19.9 months (P &lt; .001). In patients with WM, median overall survival (OS) was not reached in the fludarabine arm versus 69.8 months in the chlorambucil arm (95% CI, 61.6 to 79.8 months; P = .014). Grade 3 to 4 neutropenia was significantly higher among patients treated with fludarabine (36%) compared with patients treated with chlorambucil (17.8%; P &lt; .001). Second malignancies were significantly more frequent in the chlorambucil arm with 6-year cumulative incidence rate of 20.6% versus 3.7% in the fludarabine arm (P = .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the complete intent-to-treat study population, fludarabine significantly improved PFS compared with chlorambucil, and in patients with WM, it improved OS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2012.44.7920","type":"journal-article","created":{"date-parts":[[2012,12,11]],"date-time":"2012-12-11T21:44:06Z","timestamp":1355262246000},"page":"301-307","source":"Crossref","is-referenced-by-count":137,"title":["Results of a Randomized Trial of Chlorambucil Versus Fludarabine for Patients With Untreated Waldenstr\u00f6m Macroglobulinemia, Marginal Zone Lymphoma, or Lymphoplasmacytic Lymphoma"],"prefix":"10.1200","volume":"31","author":[{"given":"V\u00e9ronique","family":"Leblond","sequence":"first","affiliation":[{"name":"V\u00e9ronique Leblond, Florence Nguyen-Khac, and Sylvain Choquet, H\u00f4pital Piti\u00e9-Salp\u00eatriere, Assistance Publique-Hopitaux de Paris (AP-HP), Universit\u00e9 Paris 6; Sylvie Chevret, Marion Malphettes, and Julie Lejeune, H\u00f4pital Saint-Louis, AP-HP, Paris; Olivier Tournilhac, H\u00f4pital Universitaire Estaing, Clermont-Ferrand Universit\u00e9 Auvergne, Clermont-Ferrand; Pierre Morel, Hopital Schaffner, Lens; Marie-Sarah Dilhuydy, Centre Hospitalier Universitaire (CHU) Haut L\u00e9v\u00eaque, Bordeaux; Caroline Dartigeas, CHU de Tours,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Johnson","sequence":"additional","affiliation":[{"name":"V\u00e9ronique Leblond, Florence Nguyen-Khac, and Sylvain Choquet, H\u00f4pital Piti\u00e9-Salp\u00eatriere, Assistance Publique-Hopitaux de Paris (AP-HP), Universit\u00e9 Paris 6; Sylvie Chevret, Marion Malphettes, and Julie Lejeune, H\u00f4pital Saint-Louis, AP-HP, Paris; Olivier Tournilhac, H\u00f4pital Universitaire Estaing, Clermont-Ferrand Universit\u00e9 Auvergne, Clermont-Ferrand; Pierre Morel, Hopital Schaffner, Lens; Marie-Sarah Dilhuydy, Centre Hospitalier Universitaire (CHU) Haut L\u00e9v\u00eaque, Bordeaux; Caroline Dartigeas, CHU de Tours,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvie","family":"Chevret","sequence":"additional","affiliation":[{"name":"V\u00e9ronique Leblond, Florence Nguyen-Khac, and Sylvain Choquet, H\u00f4pital Piti\u00e9-Salp\u00eatriere, Assistance Publique-Hopitaux de Paris (AP-HP), Universit\u00e9 Paris 6; Sylvie Chevret, Marion Malphettes, and Julie Lejeune, H\u00f4pital Saint-Louis, AP-HP, Paris; Olivier Tournilhac, H\u00f4pital Universitaire Estaing, Clermont-Ferrand Universit\u00e9 Auvergne, Clermont-Ferrand; Pierre Morel, Hopital Schaffner, Lens; Marie-Sarah Dilhuydy, Centre Hospitalier Universitaire (CHU) Haut L\u00e9v\u00eaque, Bordeaux; Caroline Dartigeas, CHU de Tours,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Copplestone","sequence":"additional","affiliation":[{"name":"V\u00e9ronique Leblond, Florence Nguyen-Khac, and Sylvain Choquet, H\u00f4pital Piti\u00e9-Salp\u00eatriere, Assistance Publique-Hopitaux de Paris (AP-HP), Universit\u00e9 Paris 6; 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