Update on Treatment Recommendations From the Fourth International Workshop on Waldenström's Macroglobulinemia
- 1 January 2009
- journal article
- review article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 27 (1), 120-126
- https://doi.org/10.1200/jco.2008.17.7865
Abstract
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.This publication has 26 references indexed in Scilit:
- The International Prognostic Scoring System for Waldenstrom's macroglobulinemia is applicable in patients treated with rituximab-based regimensHaematologica, 2008
- Expression of the Human Concentrative Nucleotide Transporter (hCNT1) Gene Correlates with Clinical Response in Patients Affected by Waldenstrom’s Macroglobulinemia (WM), Undergoing a Combination Treatment with Cladribine (2-CdA) and Rituximab.Blood, 2007
- Fludarabine, Cyclophosphamide and Rituximab in Waldenström’s Macroglobulinemia: An Effective Regimen Requiring a New Category of Response Criteria and a Delayed Assessment of ResultsBlood, 2007
- International Prognostic Scoring System (IPSS) for Waldenström’s Macroglobulinemia (WM).Blood, 2006
- Update on treatment recommendations from the Third International Workshop on Waldenstrom's MacroglobulinemiaBlood, 2006
- Update on Recommendations for Assessing Response from the Third International Workshop on Waldenström's MacroglobulinemiaClinical Lymphoma Myeloma and Leukemia, 2006
- Report of the Third International Workshop on Waldenström's MacroglobulinemiaClinical Lymphoma, 2005
- Treatment recommendations in Waldenstrom's macroglobulinemia: Consensus Panel Recommendations from the Second International Workshop on Waldenstrom's MacroglobulinemiaSeminars in Oncology, 2003
- Prognostic markers and criteria to initiate therapy in Waldenstrom's macroglobulinemia: Consensus Panel Recommendations from the Second International Workshop on Waldenstrom's MacroglobulinemiaSeminars in Oncology, 2003
- Clinicopathological definition of Waldenstrom's macroglobulinemia: Consensus Panel Recommendations from the Second International Workshop on Waldenstrom's MacroglobulinemiaSeminars in Oncology, 2003