What are the treatment recommendations from the International Workshops on Waldenström macroglobulinemia?

Updated: May 29, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Treatment recommendations from the International Workshops on Waldenström Macroglobulinemia are as follows [32] :

  • Treatment should be based on individual patient and disease characteristics (age, comorbidities, need for rapid disease control, candidacy for autologous transplantation, cytopenias, IgM-related complications, hyperviscosity, neuropathy)

  • Combinations of rituximab with cyclophosphamide/dexamethasone, bendamustine, bortezomib/dexamethasone, or ibrutinib provide durable responses and are indicated for most patients

  • New monoclonal antibodies (ofatumumab), second-generation proteasome inhibitors (carfilzomib), and mTOR inhibitors (eg, everolimus) are promising and may expand future treatment options

  • Selection of a different regimen is typically recommended for relapsed or refractory disease, although reuse of a prior effective regimen may be appropriate in selected patients with relapsed disease after long-lasting remission

  • Autologous stem cell transplantation may be considered in young patients with chemosensitive disease and in newly diagnosed patients with very-high-risk features

Paulus et al reported that the anti-CD38 monoclonal antibody daratumumab has in vitro and in vivo (mouse model) activity against Waldenström macroglobulinemia. The therapeutic effect was augmented by cotreatment with ibrutinib, even in ibrutinib-resistant Waldenström macroglobulinemia cell lines. [33]

See also Waldenstrom Macroglobulinemia Treatment Protocols.


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