Update on treatment recommendations from the Fourth International Workshop on Waldenstrom's Macroglobulinemia.
Waldenström macroglobulinemia (WM) is a distinct B-cell lymphoproliferative disorder characterized by lymphoplasmacytic bone marrow infiltration along with an immunoglobulin M (IgM) monoclonal gammopathy. Patients with disease-related cytopenias, bulky adenopathy or organomegaly, symptomatic hyperviscosity, severe neuropathy, amyloidosis, cryoglobulinemia, cold agglutinin disease, or evidence of disease transformation should be considered for immediate therapy. Initiation of therapy should not be based on serum IgM levels alone, and asymptomatic patients should be observed. Individual patient considerations should be considered when deciding on a first-line agent including the presence of cytopenias, need for rapid disease control, age, and candidacy for autologous transplantation. Therapeutic outcomes should be evaluated using updated criteria. As part of the Fourth International Workshop on Waldenström's Macroglobulinemia, a consensus panel updated its recommendations on both first-line and salvage therapy in view of recently published and ongoing clinical trials. The panel considered encouraging results from recent studies of first-line combinations such as rituximab with nucleoside analogs with or without alkylating agents or with cyclophosphamide-based therapies (eg, cyclophosphamide, doxorubicin, vincristine, and prednisone or cyclophosphamide and dexamethasone) or the combination of rituximab with thalidomide. Such therapeutic approaches are likely to yield responses at least as good as, if not better than, monotherapy with any of the alkylating agents, nucleoside analogs, or rituximab. In the salvage setting, reuse of a first-line regimen or use of a different regimen should be considered along with bortezomib, alemtuzumab, autologous transplantation, and, in selected circumstances, allogeneic transplantation. Finally, the panel reaffirmed its encouragement of the active enrollment of patients with WM onto innovative clinical trials whenever possible.
Dimopoulos
Meletios Athanasios
MA
Department of Clinical Therapeutics, University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece. mdimop@med.uoa.gr
Gertz
Morie A
MA
Kastritis
Efstathios
E
Garcia-Sanz
Ramon
R
Kimby
Eva K
EK
Leblond
Veronique
V
Fermand
Jean-Paul
JP
Merlini
Giampaolo
G
Morel
Pierre
P
Morra
Enrica
E
Ocio
Enrique M
EM
Owen
Roger
R
Ghobrial
Irene M
IM
Seymour
John
J
Kyle
Robert A
RA
Treon
Steven P
SP
D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D004359:Drug Therapy, Combination; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077269:Lenalidomide; D011719:Pyrazines / Q000008:administration & dosage; D000069283:Rituximab; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D008258:Waldenstrom Macroglobulinemia / Q000628:therapy*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000912:Antibodies, Neoplasm; D001897:Boronic Acids; D011719:Pyrazines; D000074323:Alemtuzumab; D000069283:Rituximab; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide