A specialist applied a novel, nuanced approach to Waldenström macroglobulinemia, based on mutational status.
NEW YORK — In the wake of details about the molecular pathophysiology of Waldenström macroglobulinemia , an expert gave an update on current and expanding options for treatment.
On account of these limitations, he typically favors the alkylating agent bendamustine plus the anti-CD20 rituximab over BTK inhibitors in the absence ofmutations. This once standard approach has become less commonly used in the era of BTK inhibitors, but it is also highly effective, is generally administered in a time-limited regimen, and may be more likely to push patients into a deep remission.
“I must admit I am still under the philosophy that Waldenström’s is a chronic disease even if we are seeing a growing list of options for relapsed or poorly responding disease, so I am still not pushing patients too aggressively to knock them into a complete remission,” he said.. They are found in a small proportion of patients with other hematologic disorders, such as marginal zone lymphomas, but Stadtmauer estimated they occur in 90% of patients with WM.
For an optimal response, “you want to start therapy about 3 or 4 months before the symptoms begin,” said Stadtmauer characterizing efforts to do so as “the art of medicine.” Starting therapy just prior to symptoms is advantageous, but it involves following patients closely. Any single biomarker might not be enough.
The growing number of second-line options relieves some of the concern when patients progress. Stadtmauer said he is now using BR more often in the second-line drug now that he is using BTK inhibitor more in the first line.is highly effective and is another first- or second-line option even if this agent, like BTK inhibitors, also appears to require continuous dosing, said Stadtmauer, citing a study that showed patients relapsed relatively rapidly when the drug was stopped.
Non-Hodgkin Lymphoma NHL Waldenstrom Macroglobulinemia Macroglobulinemia Waldenstrom Syndrome Lymphoplasmacytic Lymphoma Follicular Lymphoma Biologic Therapy Biologics Multiple Myeloma Myeloma Plasma Cell Myeloma Lymphoma Malignant Lymphoma Remission Peripheral Neuropathy Antineoplastic Drug Anti-Cancer Agents Erlotinib Gefitinib Imatinib Rituximab Su11248
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