title: [Therapy of Waldenström´s macroglobulinaemia in the year 2014].
abstract: Therapy of Waldenström´s macroglobulinaemia (WM) is indicated in patients with clinically relevant symptoms. Therapeutic plasmapheresis should be performed in cases with hyperviscosity. The intensity of chemotherapy should be adjusted to the degree of cytopenia. Monotherapy with rituximab is recommended in cases with severe cytopenia, also combination of rituximab with dexamethasone should be possible. Patients with symptomatic WM without severe cytopenia should received a rituximab-containing regimens, optimal variant is combination of rituximab + dexamethasone + alkylation drug (such as cyclophosphamide or bendamustine). Possible treatment combinations are for instance R-CHOP (rituximab, cyclophosphamide, vincristine, and prednisone), R-COP (rituximab, cyclophosphamide, and prednisone), or RCD (rituximab, cyclophosphamide, and dexamethasone). The choice of regimen in individual patients will take into consideration performance status, clinical features including renal function, comorbidities and potential candidacy for stem cell transplantation.Chlorambucil and rituximab is possible treatment options for older patients. The choice of treatment of WM relapse depends on the time of treatment response. Retreatment with primary therapy may be appropriate in patients with duration of treatment response at least 2 years. Other treatment possibilities for WM relapse are regimens containing fludarabine, cladribine or bortezomib. Autologous transplantation of peripheral blood stem cells is feasible therapeutic option for relapsed WM in younger, fitter patients with aggressive chemosensitive disease.
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Adam
authors.forename: Marta
authors.initials: M
authors.lastname: Krejčí
authors.forename: Luděk
authors.initials: L
authors.lastname: Pour
authors.forename: Eva
authors.initials: E
authors.lastname: Ševčíková
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000069461:Bendamustine Hydrochloride; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009588:Nitrogen Mustard Compounds / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use; D000069283:Rituximab; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D001897:Boronic Acids; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D009588:Nitrogen Mustard Compounds; D011719:Pyrazines; D000069283:Rituximab; D014750:Vincristine; D000069286:Bortezomib; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069461:Bendamustine Hydrochloride; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone