An evaluation of Ibrutinib for the treatment of Waldenstrom macroglobulinaemia

Abstract

Waldenstrom Macroglobulinaemia (WM) is a heterogenous condition which poses a challenge to manage. Novel therapies such as Ibrutinib have been shown to be efficacious in treating WM. The landscape of Ibrutinib’s role in treating WM is everchanging with new discoveries in disease genomics and evolution together as well as through new findings in clinical trials. A systematic literature review was carried out using two databases ‘Medline’ and ‘Embase’ from 2009 to July 2019. Keywords used included ‘Ibrutinib,’ ‘Waldenstrom Macroglobulinaemia,’ and ‘lymphoma.’ There were four major clinical trials identified primarily describing outcomes of Ibrutinib in managing WM which this paper evaluates in detail. The authors present evidence of the role of Ibrutinib in the management of specific complications associated with WM. They also explore the recently discovered genomics of the disease affecting response to therapy. The evidence for the use of Ibrutinib as a treatment option for relapsed/refractory WM is compelling in MYD88 mutated WM with the response and survival rates potentially better than conventional salvage chemoimmunotherapy. There is also a case for it to be used in the frontline setting in patients unfit for conventional frontline chemoimmunotherapy.