What is the standard of care for chemotherapy to treat Waldenstrom macroglobulinemia (WM)?

Updated: Aug 06, 2020
  • Author: Joseph M Tuscano, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Numerous single and multi-agent chemotherapeutic approaches are used in the treatment of Waldenstrom macroglobulinemia (WM)/lymphoplasmacytic lymphoma (LPL); however, none is considered the standard of care, as there is a paucity of phase 3 randomized trials demonstrating a survival benefit of any one regimen over another.

Many recommendations are guided by response rates; however, some responses are more durable than others and may not predict outcome. The prognostic scoring system developed by Morel et al (2009) [1] can help to predict outcome, particularly in patients considered to have high-risk disease. Nonetheless, no prospective studies have defined an optimal regimen in any patient with WM/LPL, including high-risk patients. Many factors must be considered when deciding the best treatment approach for a given patient, including the following;

  • Age
  • Comorbidities
  • Cytopenias
  • Hyperviscosity
  • Neuropathy
  • Organ dysfunction

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