The optimal management of Waldenstrom's macroglobulinemia (WM) is in evolution, especially since the introduction of novel agents for its sister disease, multiple myeloma. Literature on the utility of autologous stem cell transplantation (ASCT) in WM, albeit mostly retrospective, supports its efficacy for symptomatic disease in eligible patients. Here, we present the experience of managing WM at our single institution. We report that ASCT improved OS/EFS in both treatment-naive and previously treated WM patients. Elevated LDH emerged as a poor prognostic factor in both univariate and multivariate analyses. Based on these data and other series of autologous SCT experience, it may be feasible to employ this strategy upfront in transplant eligible WM patients when they require a therapeutic intervention for symptomatic disease.
"Autologous stem cell transplantation produces durable responses with a low treatment-related mortality rate (Kyriakou et al, 2010; Usmani et al, 2011). Although no randomized clinical trials have addressed autologous stem cell transplantation in the first-line setting, it may be considered in transplant-eligible patients with high WM stage and increased lactate dehydrogenase level (i.e, patients with highrisk disease) (Bachanova & Burns, 2012). "
[Show abstract][Hide abstract] ABSTRACT: In this review, the key issues that pertain to Waldenström disease are discussed in a concise question-and-answer format. Diagnosis, prognosis, and indications for state-of-the-art therapy are updated. Current therapies presented at the 7th International Workshop for Waldenström Macroglobulinaemia are included.
British Journal of Haematology 05/2013; 162(3). DOI:10.1111/bjh.12367 · 4.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, and lymphadenopathy.
The presence of IgM monoclonal protein associated with ≥10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis.
Age, hemoglobin level, platelet count, β2 microglobulin, and monoclonal IgM concentrations are characteristics required for prognosis.
Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Rituximab-based therapy is used in virtually all US patients with WM and can be combined with alkylating agent or purine nucleoside analog (or both). The preferred Mayo Clinic nonstudy therapeutic induction is rituximab, cyclophosphamide, and dexamethasone. Future stem cell transplantation should be considered in induction therapy selection.
Bortezomib, thalidomide, everolimus, lenalidomide, and bendamustine have all been shown to have activity in WM. Given WM's natural history, reduction of complications will be a priority for future treatment trials. Am. J. Hematol. 88:703–711, 2013.
American Journal of Hematology 05/2012; 87(5):503-10. DOI:10.1002/ajh.23192 · 3.80 Impact Factor
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