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Ghafoor B, Masthan SS, Hameed M, Akhtar HH, Khalid A, Ghafoor S, Allah HM, Arshad MM, Iqbal I, Iftikhar A, Husnain M, Anwer F. Waldenström macroglobulinemia: a review of pathogenesis, current treatment, and future prospects. Ann Hematol 2024; 103:1859-1876. [PMID: 37414960 DOI: 10.1007/s00277-023-05345-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Waldenström macroglobulinemia (WM) is a chronic B-cell lymphoproliferative disorder characterized by lymphoplasmacytic cell overgrowth in the bone marrow and increased secretion of IgM immunoglobulins into the serum. Patients with WM have a variety of clinical outcomes, including long-term survival but inevitable recurrence. Recent advances in disease knowledge, including molecular and genetic principles with the discovery of MYD88 and CXCR4 mutations, have rapidly increased patient-tolerable treatment options. WM patients may benefit from chemotherapy regimens that include rituximab-based regimens, alkylating drugs, proteasome inhibitors, monoclonal antibodies, and drugs targeting Bruton tyrosine kinase inhibitors. In light of these advancements, patients can now receive treatment customized to their specific clinical characteristics, focusing on enhancing the depth and durability of their response while limiting the adverse effects. Despite the rapidly developing therapeutic armament against WM, a lack of high-quality evidence from extensive phase 3 trials remains a significant challenge in the research. We believe clinical outcomes will keep improving when new medicines are introduced while preserving efficacy and minimizing toxicity.
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Affiliation(s)
- Bushra Ghafoor
- Department of Internal Medicine, Capital Health Medical Center, Trenton, NJ, USA
| | | | - Maha Hameed
- Department of Internal Medicine, Florida State University/Sarasota Memorial Hospital, Sarasota, FL, USA
| | | | | | - Sana Ghafoor
- Department of Medicine and Endocrinology, Forth Valley Royal Hospital, Larbert, UK
| | | | | | - Iman Iqbal
- Clements High School, Sugarland, TX, USA
| | - Ahmad Iftikhar
- Department of Medicine, University of Arizona, Tucson, AZ, USA.
| | | | - Faiz Anwer
- Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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2
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Zanwar S, Le-Rademacher J, Durot E, D'Sa S, Abeykoon JP, Mondello P, Kumar S, Sarosiek S, Paludo J, Chhabra S, Cook JM, Parrondo R, Dispenzieri A, Gonsalves WI, Muchtar E, Ailawadhi S, Kyle RA, Rajkumar SV, Delmer A, Fonseca R, Gertz MA, Treon SP, Ansell SM, Castillo JJ, Kapoor P. Simplified Risk Stratification Model for Patients With Waldenström Macroglobulinemia. J Clin Oncol 2024:JCO2302066. [PMID: 38788183 DOI: 10.1200/jco.23.02066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE Patients with Waldenström macroglobulinemia (WM) have disparate outcomes. Newer therapies have emerged since the development of International Prognostic Scoring System, and MYD88L265P mutation is now frequently assessed at diagnosis, warranting reexamination of the prognostic parameters. PATIENTS AND METHODS We reviewed records of 889 treatment-naïve patients with active WM, consecutively seen between January 01, 1996, and December 31, 2017, to identify clinical predictors of overall survival (OS) in univariate analyses. Patients with complete data for the parameters significant on the univariate analyses (n = 341) were included in a multivariable analysis to derive a prognostic model, subsequently validated in a multi-institutional cohort. RESULTS In the derivation cohort (n = 341), age (hazard ratio [HR], 1.9 [95% CI, 1.2 to 2.1]; P = .0009), serum lactate dehydrogenase (LDH) above upper limit of normal (HR, 2.3 [95% CI, 1.3 to 4.5]; P = .007), and serum albumin <3.5 g/dL (HR, 1.5 [95% CI, 0.99 to 2.3]; P = .056) were independently prognostic. By assigning a score of 1 point each to albumin <3.5 g/dL (HR, 1.5) and age 66-75 years (HR 1.4) and 2 points for age >75 years (HR, 2.6) or elevated LDH (HR, 2.3), four groups with distinct outcomes were observed on the basis of the composite scores. Five-year OS was 93% for the low-risk (score 0), 82% for low-intermediate risk (score 1), 69% for intermediate-risk (score 2), and 55% for the high-risk (score ≥3; P < .0001) groups. In the validation cohort (N = 335), the model maintained its prognostic value, with a 5-year OS of 93%, 90%, 75%, and 57% for the four groups, respectively (P < .0001). CONCLUSION Modified Staging System for WM (MSS-WM), utilizing age, albumin, and LDH is a simple, clinically useful, and externally validated prognostic model that reliably risk-stratifies patients with symptomatic WM into four groups with distinct prognosis.
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Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer Le-Rademacher
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Eric Durot
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France
| | - Shirley D'Sa
- University College of London, London, United Kingdom
| | - Jithma P Abeykoon
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Patrizia Mondello
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Jonas Paludo
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Joselle M Cook
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wilson I Gonsalves
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Robert A Kyle
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Alain Delmer
- Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France
| | | | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Stephen M Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Prashant Kapoor
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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Yi S, Cai Z, Hu Y, He A, Gao S, Li Q, Sha L, Zhang N, Ren Y, Gai X, Yang X, Qin R, Qiu L. Ibrutinib Efficacy, Safety, and Pharmacokinetics in Chinese Patients with Relapsed or Refractory Waldenström's Macroglobulinemia: A Multicenter, Single-Arm, Phase 4 Study. Adv Ther 2024; 41:672-685. [PMID: 38079089 PMCID: PMC10838836 DOI: 10.1007/s12325-023-02720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/26/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Waldenström's macroglobulinemia (WM) is a rare malignant B cell lymphoma which occurs in around 1-2% of all hematologic tumors. Ibrutinib was approved in China for WM on the basis of two global pivotal studies which enrolled no Chinese patients. The aim of this study was to determine the efficacy, safety, and pharmacokinetics of ibrutinib in Chinese patients with relapsed or refractory (r/r) WM. METHODS This was an open-label, single-arm, multicenter phase 4 study conducted across five sites in China. Enrolled patients with clinicopathological confirmed WM received ibrutinib 420 mg once daily orally until disease progression or unacceptable toxicity. The primary endpoint was major response rate (MRR, partial response [PR], or better) according to the modified consensus criteria from the Sixth International Workshop on WM. RESULTS Seventeen patients were enrolled; at data cutoff (March 19, 2022), MRR was 64.7% (90% confidence interval [CI] 42.0-83.4) and overall response rate was 100% (90% CI 83.8-100.0). One (5.9%) patient achieved very good PR, 10 (58.8%) achieved PR, and six (35.3%) achieved minor response. The median duration of response (PR or better) was 14.8 months (95% CI 10.8-not estimable [NE]). Median progression-free survival was 18.4 months (95% CI 12.9-NE). All patients experienced at least one treatment-emergent adverse event (TEAE) related to the study drug, and grade ≥ 3 TEAEs were reported in 13 (76.5%) patients. There were no TEAEs leading to dose reduction or death. The median model estimated maximum plasma concentration and area under the plasma concentration-time curve during 24 h after dosing at steady state were 40.5 ng/mL and 204 ng·h/mL, respectively. CONCLUSIONS Ibrutinib demonstrated durable responses in Chinese patients with r/r WM. Treatment was well tolerated with no new safety signals compared with the pivotal global studies. Ibrutinib exposure was also comparable between Chinese and non-Chinese patients. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04042376.
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Affiliation(s)
- Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Aili He
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sujun Gao
- Department of Hematology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Qian Li
- Janssen China Research & Development, Beijing, China
| | - Linlin Sha
- Janssen China Research & Development, Shanghai, China
| | - Nating Zhang
- Janssen China Research & Development, Shanghai, China
| | - Yupeng Ren
- Janssen China Research & Development, Shanghai, China
| | - Xue Gai
- Janssen China Research & Development, Beijing, China
| | - Xue Yang
- Janssen China Research & Development, Shanghai, China
| | - Rui Qin
- Janssen Research & Development, Raritan, NJ, USA
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
- Tianjin Institutes of Health Science, Tianjin, China.
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Yu Y, Xiong W, Wang T, Yan Y, Lyu R, Wang Q, Liu W, An G, Sui W, Xu Y, Huang W, Zou D, Wang J, Qiu L, Yi S. Sequential treatment escalation improves survival in patients with Waldenstrom macroglobulinemia. BLOOD SCIENCE 2024; 6:e00179. [PMID: 38239572 PMCID: PMC10796142 DOI: 10.1097/bs9.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024] Open
Abstract
Waldenstrom macroglobulinemia (WM) is a type of incurable, indolent B-cell lymphoma that is prone to relapse. Over time, treatment strategies have progressed from cytotoxic drugs to rituximab (R)- or bortezomib (V)-based regimens, and have now entered into an era of Bruton tyrosine kinase inhibitor (BTKi)-based regimens. However, the optimal treatment for the relapsed patients is still unclear. Herein, we analyzed the outcomes of the first- and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy. After a median follow-up of 45.4 months, 89 patients received second-line therapy, and 53 patients were evaluated for response. The major response rates (MRR) of first- and second-line treatment were 65.1% and 67.9% (P = 0.678). The median progression-free survival (PFS) for the second-line therapy (PFS2) was shorter than that for the first-line therapy (PFS1) (56.3 vs 40.7 months, P = 0.03). However, PFS2 in targeted drugs group (R-/V-/BTKi-based regimens) was comparable to PFS1 (60.7 months vs 44.7 months, respectively, P = 0.21). Regarding second-line therapy, patients who underwent sequential treatment escalation-such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens (escalation group) -had higher MRR (80.6% vs 47.1%, respectively, P = 0.023) and longer PFS2 (50.4 vs 23.5 months, respectively, P < 0.001) compared to the non-escalation group. Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group (median, 50.4 vs 23.5 months, respectively, P = 0.039). Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.
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Affiliation(s)
- Ying Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wenjie Xiong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Tingyu Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yuting Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Rui Lyu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Qi Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wei Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Weiwei Sui
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wenyang Huang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Shuhua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology& Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
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5
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García-Sanz R, Tedeschi A. The Management of Relapsed or Refractory Waldenström's Macroglobulinemia. Hematol Oncol Clin North Am 2023:S0889-8588(23)00040-0. [PMID: 37246089 DOI: 10.1016/j.hoc.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Waldenström's macroglobulinemia (WM) is an immunoglobulin M monoclonal gammopathy produced by a bone marrow lymphoplasmacytic lymphoma, an indolent non-Hodgkin lymphoma in which the cure is still an unmet challenge. Combinations with alkylating agents, purine analogs, and monoclonal antibodies, Bruton tyrosine kinase, and proteasome inhibitors are used for the treatment of relapsed and refractory patients. Moreover, new additional agents can be seen on the horizon as potential effective therapies. No consensus on a preferred treatment in the relapsed setting is available yet.
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Affiliation(s)
- Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Accelerator Project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369 and Center for Cancer Research-IBMCC (USAL-CSIC), Paseo de San Vicente, 58-182, Salamanca 37007, Spain; Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Alessandra Tedeschi
- Department of Hematology, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Accelerator Project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369 and Center for Cancer Research-IBMCC (USAL-CSIC), Paseo de San Vicente, 58-182, Salamanca 37007, Spain; Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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6
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Arulogun SO, Brian D, Goradia H, Cooney A, Menne T, Koo R, O'Neill AT, Vos JMI, Pratt G, Turner D, Marshall K, Manos K, Anderson C, Gavriatopoulou M, Kyriakou C, Kersten MJ, Minnema MC, Koutoumanou E, El-Sharkawi D, Linton K, Talaulikar D, McCarthy H, Bishton M, Follows G, Wechalekar A, D'Sa SP. Bendamustine plus rituximab for the treatment of Waldenström Macroglobulinemia: Patient outcomes and impact of bendamustine dosing. Am J Hematol 2023; 98:750-759. [PMID: 36866925 DOI: 10.1002/ajh.26895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
Bendamustine and rituximab (BR) therapy is commonly used in the treatment of Waldenström Macroglobulinemia (WM). The impact dose of Bendamustine dose on response and survival outcomes is not well-established, and the impact of its use in different treatment settings is not clear. We aimed to report response rates and survival outcomes following BR, and clarify the impact of depth of response and bendamustine dose on survival. A total of 250 WM patients treated with BR in the frontline or relapsed settings were included in this multicenter, retrospective cohort analysis. Rates of partial response (PR) or better differed significantly between the frontline and relapsed cohorts (91.4% vs 73.9%, respectively; p < 0.001). Depth of response impacted survival outcomes: two-year predicted PFS rates after achieving CR/VGPR vs PR were 96% versus 82%, respectively (p = 0.002). Total bendamustine dose was predictive of PFS: in the frontline setting, PFS was superior in the group receiving ≥1000 mg/m2 compared with those receiving 800-999 mg/m2 (p = 0.04). In the relapsed cohort, those who received doses of <600 mg/m2 had poorer PFS outcomes compared with those who received ≥600 mg/m2 (p = 0.02). Attaining CR/VGPR following BR results in superior survival, and total bendamustine dose significantly impacts response and survival outcomes, in both frontline and relapsed settings.
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Affiliation(s)
| | | | | | - Aaron Cooney
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Tobias Menne
- Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - RayMun Koo
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australia
| | - Aideen T O'Neill
- University College, London Hospitals NHS Foundation Trust, London, UK
| | - Josephine M I Vos
- Department of Hematology & LYMMCARE, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Guy Pratt
- Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | | | | | | | - Marie J Kersten
- Department of Hematology & LYMMCARE, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | | | - Eirini Koutoumanou
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Kim Linton
- The Christie NHS Foundation Trust, Manchester, UK
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australia.,Australian National University Medical School, Canberra, Australia
| | - Helen McCarthy
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Mark Bishton
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
| | | | - Ashutosh Wechalekar
- University College, London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Shirley P D'Sa
- University College, London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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7
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Buske C, Castillo JJ, Abeykoon JP, Advani R, Arulogun SO, Branagan AR, Cao X, D'Sa S, Hou J, Kapoor P, Kastritis E, Kersten MJ, LeBlond V, Leiba M, Matous JV, Paludo J, Qiu L, Tam CS, Tedeschi A, Thomas SK, Tohidi-Esfahani I, Varettoni M, Vos JM, Garcia-Sanz R, San-Miguel J, Dimopoulos MA, Treon SP, Trotman J. Report of consensus panel 1 from the 11 th International Workshop on Waldenstrom's Macroglobulinemia on management of symptomatic, treatment-naïve patients. Semin Hematol 2023; 60:73-79. [PMID: 37099027 DOI: 10.1053/j.seminhematol.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
Consensus Panel 1 (CP1) of the 11th International Workshop on Waldenstrom's Macroglobulinemia (IWWM-11) was tasked with updating guidelines for the management of symptomatic, treatment-naïve patients with WM. The panel reiterated that watchful waiting remains the gold standard for asymptomatic patients without critically elevated IgM or compromised hematopoietic function. For first-line treatment, chemoimmunotherapy (CIT) regimens such as dexamethasone, cyclophosphamide, rituximab (DRC), or bendamustine, rituximab (Benda-R) continue to play a central role in managing WM, as they are effective, of fixed duration, generally well-tolerated, and affordable. Covalent BTK inhibitors (cBTKi) offer a continuous, generally well-tolerated alternative for the primary treatment of WM patients, particularly those unsuitable for CIT. In a Phase III randomized trial updated at IWWM-11, the second-generation cBTKi, zanubrutinib, was less toxic than ibrutinib and induced deeper remissions, thus categorizing zanubrutinib as a suitable treatment option in WM. While the overall findings of a prospective, randomized trial updated at IWWM-11 did not show superiority of fixed duration rituximab maintenance over observation following attainment of a major response to Benda-R induction, a subset analysis showed benefit in patients >65 years and those with a high IPPSWM score. Whenever possible, the mutational status of MYD88 and CXCR4 should be determined before treatment initiation, as alterations in these 2 genes predict sensitivity towards cBTKi activity. Treatment approaches for WM-associated cryoglobulins, cold agglutinins, AL amyloidosis, Bing-Neel syndrome (BNS), peripheral neuropathy, and hyperviscosity syndrome follow the common principle of reducing tumor and abnormal protein burden rapidly and deeply to improve symptoms. In BNS, ibrutinib can be highly active and produce durable responses. In contrast, cBTKi are not recommended for treating AL amyloidosis. The panel emphasized that continuous improvement of treatment options for symptomatic, treatment-naïve WM patients critically depends on the participation of patients in clinical trials, whenever possible.
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Affiliation(s)
- Christian Buske
- University Hospital Ulm, Institute of Experimental Cancer Research, Ulm, Germany.
| | | | | | | | | | | | - Xinxin Cao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marie J Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - Veronique LeBlond
- Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris France
| | - Merav Leiba
- Faculty of Health Science, Ben- Gurion University of the Negev, Israel Assuta Ashdod University Hospital; Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey V Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | | | - Lugui Qiu
- National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | | | | | | | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Josephine M Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - Ramon Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Steven P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston MA
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
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8
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Uppal E, Khwaja J, Bomsztyk J, McCarthy H, Kothari J, Walton P, Scorer H, Kyriakou C, El-Sharkawi D, D'Sa S. The Rory Morrison WMUK Registry for Waldenström macroglobulinaemia: The growth of a national registry for a rare disorder. Br J Haematol 2023; 201:905-912. [PMID: 36698318 DOI: 10.1111/bjh.18680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023]
Abstract
National registries are used globally to characterise patient demographics, treatment choices and mortality to inform and improve clinical management. Waldenström macroglobulinaemia (WM) is a rare, treatment-responsive B-cell lymphoproliferative disorder with diverse clinical features and variable outcomes. To prospectively chart changes in the management of WM in the UK, the Rory Morrison Registry (RMR) was developed to systematically collect real-world data. Here we describe the development of the RMR, demonstrate its feasibility and describe preliminary observations. The RMR was devised as a collaborative project between patients and clinicians, under the auspices of the UK Charity for WM in 2016. Patients may be registered after the point of diagnosis and those with historic diagnosis were also eligible. Data collection fields were compiled by focus groups of clinicians, patients, industry and commissioning partners. The RMR launched in November 2017 and as of March 2022, there were 22 participating centres and 1305 patients registered. Median follow-up was 6.4 years, five-year overall survival 90.7% (95% confidence interval [CI] 88.4%-92.5%) and 10-year overall survival 79.3% (95% CI 75.7%-82.4%). There has been a clear evolution in treatments including a rapid growth in the use of Bruton's tyrosine kinase inhibitors in relapsed disease since their availability in the UK.
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Affiliation(s)
| | | | | | - Helen McCarthy
- University Hospitals Dorset NHS Foundation Trust, Dorset, UK
| | - Jaimal Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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9
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Amaador K, Kersten MJ, Minnema MC, Vos JMI. Treatment of relapsed and refractory Waldenstrom Macroglobulinemia. Leuk Lymphoma 2023; 64:30-41. [PMID: 36282673 DOI: 10.1080/10428194.2022.2131423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Waldenström's Macroglobulinemia (WM) is a rare type of indolent non-Hodgkin lymphoma (NHL) that remains incurable. Several effective agents such as monoclonal antibodies (in combination with chemotherapy), Bruton's tyrosine kinase inhibitors, proteasome inhibitors, and BCL2 inhibitors are (becoming) available for the treatment of relapsed and refractory WM. There is however no consensus on a preferred treatment in the relapsed setting. Choice of therapy in relapsed WM should be individualized by taking several treatment and patients characteristics into account, such as treatment duration, toxicity, age, comorbidities and MYD88L265P and CXCR4 mutational status. Due to better understanding of WM biology and the arrival of novel anti-lymphoma agents, the therapeutic options are increasing. Non-cytotoxic and fixed duration regimens, such as those explored in other indolent NHLs should be the focus of future clinical trials in WM.
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Affiliation(s)
- Karima Amaador
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie J Kersten
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Josephine M I Vos
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Buske C, Jurczak W, Salem JE, Dimopoulos MA. Managing Waldenström's macroglobulinemia with BTK inhibitors. Leukemia 2023; 37:35-46. [PMID: 36402930 PMCID: PMC9883164 DOI: 10.1038/s41375-022-01732-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022]
Abstract
Bruton's tyrosine kinase (BTK) inhibition is one of the treatment standards for patients with relapsed/refractory Waldenström's macroglobulinemia (WM) and for patients with WM who are unsuitable for immunochemotherapy (ICT). It offers deep and durable responses with a manageable safety profile that is generally favorable compared with ICT regimens. However, the limitations of the first approved BTK inhibitor (BTKi), ibrutinib, include reduced efficacy in patients lacking the characteristic WM mutation (MYD88L265P) and toxicities related to off-target activity. The risk of atrial fibrillation (AF) and other cardiovascular side effects are a notable feature of ibrutinib therapy. Several next-generation covalent BTKis with greater selectivity for BTK are at various stages of development. In November 2021, zanubrutinib became the first of these agents to be approved by the European Medicines Agency for the treatment of WM. Head-to-head trial data indicate that it has comparable efficacy to ibrutinib for patients with WM overall, although it may be more effective in patients with CXCR4 mutations or wild-type MYD88. In the clinical trial setting, its greater selectivity translates into a reduced risk of cardiovascular side effects, including AF. Acalabrutinib, which is pre-approval in WM, appears to offer similar advantages over ibrutinib in terms of its safety profile. Beyond the next-generation covalent BTKis, non-covalent BTKis are an emerging class with the potential to provide a therapeutic option for patients who relapse on covalent BTKis. In the future, BTKis may be increasingly utilized within combination regimens. Several ongoing trials in WM are investigating the potential for BTKi use in combination with established and novel targeted agents.
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Affiliation(s)
- Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center, University Hospital of Ulm, Ulm, Germany.
| | - Wojciech Jurczak
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Joe-Elie Salem
- Sorbonne University, AP-HP, INSERM CIC-1901, Paris, France
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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11
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Should Patients with Waldenström Macroglobulinemia Receive a BTK Inhibitor as Frontline Therapy? HEMATO 2022. [DOI: 10.3390/hemato3040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Waldenström Macroglobulinemia (WM) is a rare indolent lymphoma with heterogeneous clinical presentation. As there are no randomised trials suggesting the best treatment option in treatment-naive patients, guidelines suggest either rituximab-combining regimens or BTK-inhibitors (BTKi) as feasible alternatives. Several factors play in the decision-making process: patients’ age and fitness, disease characteristics and genotype. Chemoimmunotherapy (CIT) represents a fixed-duration, less expensive and effective option, able to achieve prolonged time-to-next treatment even in patients with unfavourable genotypes. Immunosuppression and treatment-related second cancers may represent serious concerns. Proteasome-inhibitor-based regimens are effective with rapid disease control, although bortezomib-related neuropathy discourages the choice of these agents and treatment schedules may not be easily manageable in the elderly. BTKi have demonstrated high rates of response and prolonged survival together with the convenience of an oral administration and limited cytopenias. However, outcomes are impacted by genotype and some concerns remain, in particular the continuous drug exposure that may result in extra-haematological complications and drug resistance. Although next-generation BTKi have improved treatment tolerance, the question whether BTKi should be offered as frontline therapy to every patient is still debated. Giving fixed-duration schedule, prolonged time-to-next treatment and outcomes independent of genotype, CIT is still our preferred choice in WM. However, BTKi remain a valuable option in frail patients unsuitable for CIT.
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12
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Riva E, Duarte PJ, Valcárcel B, Remaggi G, Murrieta I, Corzo A, del Carpio D, Peña C, Vásquez J, Bove V, Teixeira L, Fleury-Perini G, Yantorno S, Samánez C, Lopresti S, Altamirano M, Villela L, Ruiz-Arguelles GJ, Ruiz-Delgado GJ, Montaño E, Verri V, Zamora Pérez E, Pérez Jacobo F, Idrobo H, Martínez-Cordero H, Beltran BE, Ramírez J, Castillo JJ, Malpica Castillo LE. Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study. JCO Glob Oncol 2022; 8:e2100380. [PMID: 35939775 PMCID: PMC9470138 DOI: 10.1200/go.21.00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America. Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features. Data from Latin American WM patients are lacking. In this article, we report, for the first time, the results of a retrospective analysis focused on the clinical, therapy, and outcome patterns of WM in Latin America. Moreover, we have validated the IPSSWM score as a prognostic factor for mortality and disease progression. Despite the limitations we acknowledge, this is the first study to provide novel real-world data on WM in Latin America.
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Affiliation(s)
- Eloísa Riva
- Hematology Department, Hospital Británico & Hospital de Clinicas, Montevideo, Uruguay
| | | | - Bryan Valcárcel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | | | - Ariel Corzo
- Hospital de Clínicas de Buenos Aires, Buenos Aires, Argentina
| | | | - Camila Peña
- Hospital del Salvador, Santiago de Chile, Chile
| | - Jule Vásquez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Virginia Bove
- Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | | | | | | | - Sergio Lopresti
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | - Luis Villela
- Centro Médico Dr Ignacio Chavez, Hospital Fernando Ocaranza, Universidad del Valle, Mexico City, Mexico
| | | | | | | | - Verónica Verri
- Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Luis E. Malpica Castillo
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
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13
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Hu X, Wang H, Yuan D, Qu H, Li Y, Wang N, Wang X, Liu X, Xu H, Zhang Y, Wang X. An Extended Prognostic Index of the ISSWM Score Based on Thyroid Complications in Waldenström Macroglobulinemia/Lymphoplasmacytoid Lymphoma. Front Oncol 2022; 12:870258. [PMID: 35646661 PMCID: PMC9136013 DOI: 10.3389/fonc.2022.870258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
Waldenström macroglobulinemia/lymphoplasmacytoid lymphoma (WM/LPL) is a rare lymphoproliferative neoplasm characterized by clonally related lymphocytes, lymphoplasmacytic cells, and plasma cell proliferation. WM/LPL patients commonly present with elevated immunoglobulin, predominantly immunoglobulin M (IgM). Previous studies reported that thyroid dysfunction was associated with the development and progression of solid tumors. However, only limited information is available on the correlation between thyroid complications and lymphoid malignancies. The aim of our study was to explore the prognostic significance of thyroid complications in WM/LPL. Herein, 13.3% of WM/LPL patients were diagnosed with thyroid complications, which were significantly associated with unfavorable progression-free survival (PFS), overall survival (OS), and adverse treatment response. Co-existing thyroid disease was significantly related to alleviated serum IgM levels, providing an answer to practical problems. Furthermore, the presence of thyroid complications was identified as an independent prognostic indicator for PFS in WM/LPL. Incorporating the ISSWM score with thyroid complications was superior to ISSWM alone in risk stratification and prognostic prediction. Furthermore, subgroup analyses of WM/LPL patients revealed that subclinical hypothyroidism predicted undesirable outcomes at the early stage. These results were also supported by independent microarray dataset analyses. In conclusion, the primary strength of this study is that it provides robust real-world evidence on the prognostic role of thyroid complications, highlighting further clinical concerns in the management of WM/LPL patients.
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Affiliation(s)
- Xinting Hu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Hua Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Dai Yuan
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huiting Qu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Li
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Na Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianghua Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Liu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xin Wang, ; Ya Zhang,
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xin Wang, ; Ya Zhang,
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14
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Elessa D, Debureaux PE, Villesuzanne C, Davi F, Bravetti C, Harel S, Talbot A, Oksenhendler E, Malphettes M, Thieblemont C, Moatti H, Maarek O, Arnulf B, Royer B. Inflammatory Waldenström's macroglobulinaemia: A French monocentric retrospective study of 67 patients. Br J Haematol 2022; 197:728-735. [PMID: 35393650 DOI: 10.1111/bjh.18157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/23/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
Waldenström's macroglobulinaemia (WM) is a B-cell neoplasm resulting from bone marrow lymphoplasmacytic infiltration and monoclonal IgM secretion. Some patients present concomitant inflammatory syndrome attributed to the disease activity; we named this syndrome inflammatory WM (IWM). We retrospectively analysed all WM patients seen in a single tertiary referral centre from January 2007 to May 2021, and after excluding aetiologies for the inflammatory syndrome using a pertinent blood workup, including C-reactive protein (CRP), and imaging, we identified 67 (28%) IWM, 166 (68%) non-IWM, and nine (4%) WM with inflammatory syndrome of unknown origin. At treatment initiation, IWM patients had more severe anaemia (median Hb 90 vs 99 g/l; p < 0.01), higher platelet count (median 245 vs 196 × 109/l; p < 0.01) and comparable serum IgM level (median 24.9 vs 23.0 g/l; p = 0.28). A positive correlation was found between inflammatory and haematological responses (minimal response or better) (odds ratio 32.08; 95% confidence interval 8.80-98.03; p < 0.001). Overall survivals (OS) were similar (median OS: 17 vs 20 years; p = 0.11) but time to next treatment (TNT) was significantly shorter for IWM (TNT1: 1.6 vs 4.8 years, p < 0.0001). IWM mostly shared the same presentation and outcome as WM without inflammatory syndrome.
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Affiliation(s)
- Dikelele Elessa
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Pierre-Edouard Debureaux
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Camille Villesuzanne
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Frederic Davi
- Laboratory of Haematology, Hopital Pitie-Salpetriere, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Clotilde Bravetti
- Laboratory of Haematology, Hopital Pitie-Salpetriere, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stephanie Harel
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Alexis Talbot
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Eric Oksenhendler
- University of Paris, Paris, France.,Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marion Malphettes
- University of Paris, Paris, France.,Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Catherine Thieblemont
- University of Paris, Paris, France.,Department of Haemato-Oncology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hannah Moatti
- University of Paris, Paris, France.,Department of Haemato-Oncology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Odile Maarek
- University of Paris, Paris, France.,Laboratory of Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bertrand Arnulf
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Bruno Royer
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
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15
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Elamin G, Aljoundi A, Soliman MES. Multi-catalytic Sites Inhibition of Bcl2 Induces Expanding of Hydrophobic Groove: A New Avenue Towards Waldenström Macroglobulinemia Therapy. Protein J 2022; 41:201-215. [PMID: 35237907 DOI: 10.1007/s10930-022-10046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
B-cell lymphoma 2 (Bcl2) is a key protein regulator of apoptosis. The hydrophobic groove in Bcl2 is a unique structural feature to this class of enzymes and found to have a profound impact on protein overall structure, function, and dynamics. Dynamics of the hydrophobic groove is an essential determinant of the catalytic activity of Bcl2, an implicated protein in Waldenström macroglobulinemia (WM). The mobility of α3-α4 helices around the catalytic site of the protein remains crucial to its activity. The preferential binding mechanisms of the multi-catalytic sites of the Bcl2 enzyme have been a subject of debate in the literature. In addition to our previous report on the same protein, herein, we further investigate the preferential binding modes and the conformational implications of Venetoclax-JQ1 dual drug binding at both catalytic active sites of Bcl2. Structural analysis revealed asymmetric α3-α4 helices movement with the expansion of the distance between the α3 and α4 helix in Venetoclax-JQ1 dual inhibition by 15.2% and 26.3%, respectively when compared to JQ1 and Venetoclax individual drug inhibition-resulting in remarkable widening of hydrophobic groove. Moreso, a reciprocal enhanced binding effect was observed: Venetoclax increased the binding affinity of JQ1 by 11.5%, while the JQ1 fostered the binding affinity of Venetoclax by 16.3% compared with individual inhibition of each drug. This divergence has also resulted in higher protein stability, and prominent correlated motions were observed with the least fluctuations and multiple van der Waals interactions. Findings offer vital conformational dynamics and structural mechanisms of enzyme-single ligand and enzyme-dual ligand interactions, which could potentially shift the current therapeutic protocol of Waldenström macroglobulinemia.
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Affiliation(s)
- Ghazi Elamin
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Aimen Aljoundi
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa
| | - Mahmoud E S Soliman
- Molecular Bio-Computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4001, South Africa.
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16
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Abeykoon JP, Zanwar S, Ansell SM, Muchtar E, He R, Greipp PT, King RL, Ailawadhi S, Paludo J, Larsen JT, Habermann TM, Inwards D, Go RS, Thanarajasingam G, Buadi F, Dispenzieri A, Thompson CA, Witzig TE, Lacy M, Gonsalves W, Nowakowski GS, Dingli D, Rajkumar SV, Kyle RA, Sher T, Roy V, Rosenthal A, Chanan‐Khan AA, Reeder C, Gertz MA, Kumar S, Kapoor P. Assessment of fixed-duration therapies for treatment-naïve Waldenström macroglobulinemia. Am J Hematol 2021; 96:945-953. [PMID: 33909933 DOI: 10.1002/ajh.26210] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/24/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022]
Abstract
Comparative data guiding initial therapy for Waldenström macroglobulinemia (WM), an infrequently encountered non-Hodgkin lymphoma, are sparse. We evaluated three commonly used rituximab-based frontline regimens: rituximab-bendamustine (R-Benda); dexamethasone, rituximab, cyclophosphamide (DRC); and bortezomib, dexamethasone, rituximab (BDR) in 220 treatment-naïve patients with WM, seen at Mayo Clinic between November 1, 2000 and October 31, 2019. The median follow-up was 4.5 (95%CI: 4-5) years. The R-Benda cohort (n = 83) demonstrated superior overall response rate (ORR: 98%), in comparison to DRC (n = 92, ORR: 78%) or BDR (n = 45, ORR: 84%) cohorts, p = 0.003. Similarly, longer progression-free survival (PFS) was evident with R-Benda use [median 5.2 vs. 4.3 (DRC) and 1.8 years (BDR), p < 0.001]. The time-to-next therapy (TTNT) favored R-Benda [median, not-reached, 4.4 (DRC) and 2.6 years (BDR), p < 0.001). These endpoints were comparable between the DRC and BDR cohorts. Overall survival (OS) was similar across the three cohorts, p = 0.77. In a subset analysis of 142 patients genotyped for MYD88L265P mutation, the ORR, PFS and TTNT were unaffected by the patients' MYD88 signature within each cohort. In conclusion, ORR, PFS and TTNT with R-Benda are superior compared to DRC or BDR in treatment-naïve patients with active WM. The patient outcomes with any one of these three regimens are unaffected by the MYD88L265P mutation status.
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Affiliation(s)
| | - Saurabh Zanwar
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Eli Muchtar
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Rong He
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Patricia T. Greipp
- Division of Laboratory Genetics and Genomics Mayo Clinic Rochester Minnesota USA
| | - Rebecca L. King
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Sikander Ailawadhi
- Division of Hematology and Oncology Mayo Clinic Jacksonville Florida USA
| | - Jonas Paludo
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - David Inwards
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Francis Buadi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | | | - Martha Lacy
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | | | - David Dingli
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | | | - Robert A. Kyle
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Taimur Sher
- Division of Hematology and Oncology Mayo Clinic Jacksonville Florida USA
| | - Vivek Roy
- Division of Hematology and Oncology Mayo Clinic Jacksonville Florida USA
| | | | | | - Craig Reeder
- Division of Hematology Mayo Clinic Phoenix Arizona USA
| | - Morie A. Gertz
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Shaji Kumar
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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17
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Pessach I, Dimopoulos MA, Kastritis E. Managing complications secondary to Waldenström's macroglobulinemia. Expert Rev Hematol 2021; 14:621-632. [PMID: 34170207 DOI: 10.1080/17474086.2021.1947236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Waldenström's macroglobulinemia (WM) is a rare lymphoma characterized by the accumulation of IgM-secreting lymphoplasmacytic cells in the bone marrow and other organs. Clinical sequelae relate to direct tissue infiltration by malignant cells but also to the physicochemical and immunological properties of the monoclonal IgM, resulting in a variety of disease-related complications.Areas covered: This narrative review, following a thorough Pubmed search of pertinent published literature, discusses complications secondary to WM, related to direct tumor infiltration, monoclonal IgM circulation, and deposition, as well as other less common ones. The description and pathophysiology of these complications were described together with their specific management strategies and in the context of available treatment options for WM (anti-CD20 monoclonal antibody-based combinations, proteasome inhibitors, BTK inhibitors, and other emerging ones).Expert opinion: The availability of many novel, active and less toxic regimens for the treatment of WM allows the management of the disease with strategies that depend on clinical presentation and disease-related complications, age, toxicity considerations, and presence of comorbidities.
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Affiliation(s)
- Ilias Pessach
- Division of Hematology, Athens Medical Center, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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18
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Cao XX, Yi SH, Jiang ZX, He JS, Yang W, Du J, Sun CY, Wu Y, Chen WM, Liu XJ, Li BZ, Li CR, Sang W, Liu QH, Chu XX, Li F, Bai O, Mao M, Fu R, Wang W, Liu LH, Wang LQ, Dong YJ, Luo J, Li ZL, Wei YQ, Zhang QK, Liu J, Ding KY, Zou L, Chen BY, Hua LM, Jing HM, He J, Wang L, Li J, Qiu LG. Treatment and outcome patterns of patients with Waldenström's macroglobulinemia: a large, multicenter retrospective review in China. Leuk Lymphoma 2021; 62:2657-2664. [PMID: 34105439 DOI: 10.1080/10428194.2021.1938030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this study, we aimed to investigate treatment options and the prognosis of patients with WM in China. This retrospective study included 1141 patients diagnosed with symptomatic WM between January 2003 and December 2019 at 35 tertiary hospitals in 22 provinces of China. Fifty-four patients (7.3%) received monotherapy, 264 (36.0%) received chemoimmunotherapy, 395 (53.8%) received other combination regimens without rituximab, and 21 (2.9%) received ibrutinib. Using a multivariable Cox regression model, age > 65 years old, platelets <100 × 109/L, serum albumin <3.5 g/dl, β2 microglobulin concentration ≥4 mg/L and LDH ≥250 IU/L predicted poor OS. In summary, our study showed that frontline treatment choices for WM are widely heterogeneous. We validated most of the established prognostic factors in the rIPSS (age >65 years, LDH ≥250 IU/L, ALB <3.5 g/dl and β2 microglobulin ≥4 mg/L) together with PLT ≤ 100 × 109/L indicate a poor prognosis for patients with WM.
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Affiliation(s)
- Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shu-Hua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital & Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhong-Xing Jiang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jing-Song He
- Department of Hematology, Bone Marrow Transplantation Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Liaoning, China
| | - Juan Du
- Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Chun-Yan Sun
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yu Wu
- Department of Hematology, West China Hospital of Sichuan University, Sichuan, China
| | - Wen-Ming Chen
- Department of Hematology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, China
| | - Xiao-Jun Liu
- Department of Hematology, The Second Hospital of Hebei Medical University, Hebei, China
| | - Bing-Zong Li
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Chun-Rui Li
- Department of Hematology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei, China
| | - Wei Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Qin-Hua Liu
- Department of Hematology, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Xiao-Xia Chu
- Department of Hematology, Yuhuangding Hospital of Yantai, Shandong, China
| | - Fei Li
- Department of Hematology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Ou Bai
- Department of Hematology, The First Affiliated Hospital of Jilin University, Jilin, China
| | - Min Mao
- Department of Hematology, Xinjiang Uyghur Municipal People's Hospital, Xinjiang, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Wang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Li-Hong Liu
- Department of Hematology, The fourth Hospital of Hebei Medical University, Hebei, China
| | - Lu-Qun Wang
- Department of Hematology, Qilu Hospital of Shandong University, Shandong, China
| | - Yu-Jun Dong
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Jun Luo
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zhen-Ling Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing China
| | - Yong-Qiang Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangdong, China
| | - Qi-Ke Zhang
- Department of Hematology, Gansu Provincial Hospital, Gansu, China
| | - Jing Liu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Kai-Yang Ding
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Anhui, China
| | - Liang Zou
- Department of Hematology, Hubei, China
| | - Bi-Yun Chen
- Department of Hematology, Fujian Provincial Hospital, Fujian, China
| | - Luo-Ming Hua
- Department of Hematology, The Affiliated Hospital of Hebei University, Hebei, China
| | - Hong-Mei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Juan He
- Department of Hematology, The First Hospital of China Medical University, Liaoning, China
| | - Liang Wang
- Department of Hematology, Zhujiang Hospital of Southern Medical University, Guangdong, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lu-Gui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Blood Diseases Hospital & Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Tohidi‐Esfahani I, Warden A, Malunis E, DeNardis PL, Haurat J, Black M, Opat S, Kee D, D'Sa S, Kersten MJ, Spearing RL, Palomba ML, Olszewski AJ, Harrington C, Scott CL, Trotman J. WhiMSICAL: A global Waldenström's Macroglobulinemia patient-derived data registry capturing treatment and quality of life outcomes. Am J Hematol 2021; 96:E218-E222. [PMID: 33755232 DOI: 10.1002/ajh.26173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Ibrahim Tohidi‐Esfahani
- Haematology Department Concord Repatriation General Hospital Sydney Australia
- Faculty of Medicine and Health University of Sydney Sydney Australia
| | - Andrew Warden
- Australian Patient Support Group for WM WMozzies Sydney Australia
| | - Elena Malunis
- Board of Trustees International Waldenström's Macroglobulinemia Foundation Sarasota Florida
| | - Peter L. DeNardis
- Board of Trustees International Waldenström's Macroglobulinemia Foundation Sarasota Florida
| | - Javier Haurat
- Administrative Team BioGrid Australia Melbourne Australia
- Administrative Team CART‐WHEEL.org Melbourne Australia
| | - Marita Black
- Administrative Team BioGrid Australia Melbourne Australia
- Administrative Team CART‐WHEEL.org Melbourne Australia
| | - Stephen Opat
- School of Clinical Sciences Monash University Melbourne Australia
- Haematology Department Monash Health Melbourne Australia
| | - Damien Kee
- Cancer Research Division Walter and Eliza Hall Institute of Medical Research Melbourne Australia
- Oncology Department Peter MacCallum Cancer Centre Melbourne Australia
- Department of Medicine University of Melbourne Melbourne Australia
| | - Shirley D'Sa
- UCLH Centre for Waldenström's Macroglobulinemia and Related Conditions University College London Hospitals NHS Foundation Trust London UK
| | - Marie José Kersten
- Department of Hematology Amsterdam UMC, University of Amsterdam and LYMMCARE Netherlands
| | - Ruth L. Spearing
- Otago School of Medicine University of Otago New Zealand
- Department of Haematology Christchurch Hospital New Zealand
| | - Maria Lia Palomba
- Lymphoma Service, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York
- Department of Medicine Weill Cornell Medical College New York New York
| | - Adam J. Olszewski
- Department of Medicine Warren Alpert Medical School, Brown University Providence Rhode Island
- Division of Hematology‐Oncology Rhode Island Hospital Providence Rhode Island
| | - Carl Harrington
- Board of Trustees International Waldenström's Macroglobulinemia Foundation Sarasota Florida
| | - Clare L. Scott
- Administrative Team CART‐WHEEL.org Melbourne Australia
- Cancer Research Division Walter and Eliza Hall Institute of Medical Research Melbourne Australia
- Department of Medical Oncology Royal Melbourne Hospital Melbourne Australia
| | - Judith Trotman
- Haematology Department Concord Repatriation General Hospital Sydney Australia
- Faculty of Medicine and Health University of Sydney Sydney Australia
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20
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Ixazomib, dexamethasone, and rituximab in treatment-naive patients with Waldenström macroglobulinemia: long-term follow-up. Blood Adv 2021; 4:3952-3959. [PMID: 32822482 DOI: 10.1182/bloodadvances.2020001963] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022] Open
Abstract
Proteasome inhibition is a standard of care for the primary treatment of patients with Waldenström macroglobulinemia (WM). We present the long-term follow-up of a prospective, phase II clinical trial that evaluated the combination of ixazomib, dexamethasone, and rituximab (IDR) in 26 treatment-naive patients with WM. IDR was administered as 6 monthly induction cycles followed by 6 every-2-month maintenance cycles. The MYD88 L265P mutation was detected in all patients, and CXCR4 mutations were detected in 15 patients (58%). The median time to response (TTR) and time to major response (TTMR) were 2 and 6 months, respectively. Patients with and without CXCR4 mutations had median TTR of 3 months and 1 month, respectively (P = .003), and median TTMR of 10 months and 3 months, respectively (P = .31). The overall, major, and very good partial response (VGPR) rates were 96%, 77%, and 19%, respectively. The rate of VGPR in patients with and without CXCR4 mutations were 7% and 36%, respectively (P = .06). The median progression-free survival (PFS) was 40 months, the median duration of response (DOR) was 38 months, and the median time to next treatment (TTNT) was 40 months. PFS, DOR, and TTNT were not affected by CXCR4 mutational status. The safety profile was excellent with no grade 4 adverse events or deaths to date. IDR provides a safe and effective frontline treatment option for symptomatic patients with WM. This study was registered at www.clinicaltrials.gov as #NCT02400437.
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21
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Treatment Patterns and Outcomes in a Nationwide Cohort of Older and Younger Veterans with Waldenström Macroglobulinemia, 2006-2019. Cancers (Basel) 2021; 13:cancers13071708. [PMID: 33916545 PMCID: PMC8038459 DOI: 10.3390/cancers13071708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Waldenström macroglobulinemia is a rare cancer about which little is known. Evidence from real-world settings provides invaluable information to patients and clinicians, especially for older and/or frailer patients, a demographic often excluded from clinical trials. This study provides information about treatment patterns and outcomes from real-world cohorts of older (>70 years) and younger (≤70 years) patients. We report findings across early (2006–2012) and modern (2013–2019) eras, reflecting a transition during which the number of treatments available for Waldenström macroglobulinemia rapidly increased. We found marked improvements in treatment outcomes among older patients in the modern vs early era, with little or no improvement in outcomes among younger patients. Our findings emphasize the importance of real-world evidence in guiding patient-specific treatment decisions. Abstract Little is known about real-world treatment patterns and outcomes in Waldenström macroglobulinemia (WM) following the recent introduction of newer treatments, especially among older adults. We describe patterns of first-line (1 L) WM treatment in early (2006–2012) and modern (2013–2019) eras and report outcomes (overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse event (AE)-related discontinuation) in younger (≤70 years) and older (>70 years) populations. We followed 166 younger and 152 older WM patients who received 1 L treatment between January 2006 and April 2019 in the Veterans Health Administration. Median follow-up was 43.5 months (range: 0.6–147.2 months). Compared to the early era, older patients in the modern era achieved improved ORRs (early: 63.8%, modern: 72.3%) and 41% lower risk of death/progression (hazard ratio (HR) for PFS: 0.59, 95% CI (confidence interval): 0.36–0.95), with little change in AE-related discontinuation between eras (HR: 0.82, 95% CI: 0.4–1.7). In younger patients, the AE-related discontinuation risk increased almost fourfold (HR: 3.9, 95% CI: 1.1–14), whereas treatment effects did not change between eras (HR for OS: 1.4, 95% CI: 0.66–2.8; HR for PFS: 1.1, 95% CI: 0.67–1.7). Marked improvements in survival among older adults accompanied a profound shift in 1 L treatment patterns for WM.
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22
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Owen RG. Bruton Tyrosine Kinase Inhibitors in Waldenstrom Macroglobulinemia: Unprecedented Clinical Activity and Promising Future Directions. J Clin Oncol 2021; 39:548-550. [PMID: 33444081 DOI: 10.1200/jco.20.02942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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23
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Varettoni M, Ferrari A, Frustaci AM, Ferretti VV, Rizzi R, Motta M, Piazza F, Merli M, Benevolo G, Visco C, Laurenti L, Ferrero S, Gentile M, Del Fabro V, Abbadessa A, Klersy C, Musto P, Fabbri N, Deodato M, Dogliotti I, Greco C, Corbingi A, Luminari S, Arcaini L. Younger patients with Waldenström Macroglobulinemia exhibit low risk profile and excellent outcomes in the era of immunotherapy and targeted therapies. Am J Hematol 2020; 95:1473-1478. [PMID: 32780514 DOI: 10.1002/ajh.25961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022]
Abstract
We analyzed 160 young Waldenström Macroglobulinemia (WM) patients with a median age of 49 years (range 23-55 years), diagnosed between January 2000 and January 2019 in 14 Italian centers. At diagnosis, 70% of patients were asymptomatic. With a median follow-up of 5.6 years, 57% have been treated. As initial therapy 79% of patients received chemo-immunotherapy, 13% a chemo-free induction and 8% chemotherapy only. At relapse or progression, 6% underwent an autologous stem cell transplantation. Overall, 19% of patients received ibrutinib during the course of the disease. According to IPSSWM, 63% were classified as low risk, 27% as intermediate risk and 10% as high risk. Five-year OS was shorter in high-risk as compared with low or intermediate risk patients (92.9% vs 100% P = .002). According to revised IPSSWM, 92% were classified as very low or low risk and 8% as intermediate risk, with a shorter 5-year OS in the latter group (87.5% vs 100%, P = .028). The OS of young WM patients was not significantly reduced as compared with age-matched, sex-matched and calendar year-matched general population. Early diagnosis, absence of high-risk features in symptomatic patients and high efficacy of modern treatments are the main determinants of the excellent outcome of young WM patients.
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Affiliation(s)
- Marzia Varettoni
- Division of Hematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Angela Ferrari
- Hematology Unit Azienda USL IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Anna M. Frustaci
- Department of Hematology Niguarda Cancer Center, Niguarda Hospital Milan Italy
| | - Virginia V. Ferretti
- Service of Biometry and Clinical Epidemiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Rita Rizzi
- Department of Emergency and Organ Transplantation "Aldo Moro" University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOU Consorziale Policlinico Bari Italy
| | - Marina Motta
- Department of Hematology ASST‐Spedali Civili Brescia Italy
| | - Francesco Piazza
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section Padua University School of Medicine Padua Italy
| | - Michele Merli
- Division of Hematology Ospedale di Circolo e Fondazione Macchi ‐ ASST Sette Laghi Varese Italy
| | - Giulia Benevolo
- Department of Hematology Cittaʼ della Salute e della Scienza Torino Italy
| | - Carlo Visco
- Medicine, Section of Hematology University of Verona Verona Italy
| | - Luca Laurenti
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Roma Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences University of Torino, Italy/AOU “Città della Salute e della Scienza di Torino” Torino Italy
| | | | - Vittorio Del Fabro
- Division of Hematology Azienda Policlinico‐OVE, University of Catania Catania Italy
| | | | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation "Aldo Moro" University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOU Consorziale Policlinico Bari Italy
| | - Nicole Fabbri
- Department of Molecular Medicine University of Pavia Pavia Italy
| | - Marina Deodato
- Department of Hematology Niguarda Cancer Center, Niguarda Hospital Milan Italy
| | - Irene Dogliotti
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences University of Torino, Italy/AOU “Città della Salute e della Scienza di Torino” Torino Italy
| | | | - Andrea Corbingi
- Dipartimento Universitario di Scienze Radiologiche ed Ematologiche Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Roma Italy
| | - Stefano Luminari
- Hematology Unit Azienda USL IRCCS di Reggio Emilia Reggio Emilia Italy
- Department CHIMOMO University of Modena and Reggio Emilia Reggio Emilia Italy
| | - Luca Arcaini
- Division of Hematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
- Department of Molecular Medicine University of Pavia Pavia Italy
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Kumar S, Sanjeev, Rahman K, Singh MK, Chandra D, Gupta A, Gupta R, Kashyap R, Nityanand S. Waldenström Macroglobulinemia: Clinico-pathological Profile and Treatment Outcomes of Patients from a Tertiary Care Centre of North India. Indian J Hematol Blood Transfus 2020; 37:386-390. [PMID: 34267456 DOI: 10.1007/s12288-020-01382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
Waldenstorms Macroglobulinemia (WM) is a rare mature B cell neoplasm characterized by a lymphoplasmacytic lymphoma and an IgM monoclonal protein. It is managed by Rituximab based chemotherapy. A single-centre retrospective study was carried out to analyse the clinical presentation, laboratory features, and treatment outcomes of all consecutive patients of WM, diagnosed over a period of 86 months. First-line treatment regimens included RCD (Rituximab/Cyclophosphamide/Dexamethasone), BDR (Bortezomib /Dexamethasone/ Rituximab) and (Lenalidomide/Dexamethasone). A total of 26 patients of WM were diagnosed during this period, with a median age of 65 years. Majority (89%) of these patients were of intermediate (47%) to high risk (42%). An overall response rate of 76.4% was achieved. RCD was found superior to BDR in terms of treatment response. For those who required 2nd line chemotherapy, the median time to next treatment was 22 months. To conclude, a late presentation and higher risk categories were common in our cohort of patients. Treatment outcome was comparable to those reported in western literature. RCD regimen was found to be a better treatment option in terms of overall survival.
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Affiliation(s)
- Sujeet Kumar
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Sanjeev
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Khaliqur Rahman
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Manish Kumar Singh
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Dinesh Chandra
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Anshul Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Ruchi Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Rajesh Kashyap
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
| | - Soniya Nityanand
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, U.P. India
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25
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Castillo JJ, Advani RH, Branagan AR, Buske C, Dimopoulos MA, D'Sa S, Kersten MJ, Leblond V, Minnema MC, Owen RG, Palomba ML, Talaulikar D, Tedeschi A, Trotman J, Varettoni M, Vos JM, Treon SP, Kastritis E. Consensus treatment recommendations from the tenth International Workshop for Waldenström Macroglobulinaemia. LANCET HAEMATOLOGY 2020; 7:e827-e837. [DOI: 10.1016/s2352-3026(20)30224-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
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26
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Despina F, Meletios Athanasios D, Efstathios K. Emerging drugs for the treatment of Waldenström macroglobulinemia. Expert Opin Emerg Drugs 2020; 25:433-444. [PMID: 32955949 DOI: 10.1080/14728214.2020.1822816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Waldenström's Macroglobulinemia (WM) is an indolent lymphoma with uniquely distinct and heterogenous clinical and genomic profiles. Clonal lymphoplasmacytic cells secrete monoclonal IgM. More than 90% of patients harbor a mutation in MYD88 gene, leading to the constitutive activation of downstream pathways, involving BTK-mediated signaling. The use of BTK inhibitors has changed the treatment landscape of WM and has paved the way for new approaches to therapy. AREAS COVERED WM is an orphan disease and ibrutinib is the only FDA/EMA approved agent. Currently established agent combinations will be reviewed with a focus on emerging therapeutic options. These include second generation inhibitors, agents that target other molecules in the BCR signaling pathway, CXCR4 inhibitors, proteasome inhibitors and anti-CD38 antibodies. The current research goal is to establish a combination that can induce deep and durable responses with minimal associated toxicity. In addition, agents that can overcome ibrutinib resistance or act in a synergistic manner with BTKi are under investigation. EXPERT OPINION The optimal therapeutic approach for WM patients is not currently established. The question of whether a combinatory (or synergistic) regimen to overcome resistance and allow for fixed- duration treatment will allow for deep/durable responses is being addressed in ongoing clinical trials.
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Affiliation(s)
- Fotiou Despina
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens , Athens, Greece
| | - Dimopoulos Meletios Athanasios
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens , Athens, Greece
| | - Kastritis Efstathios
- Plasma Cell Dyscrasia Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens , Athens, Greece
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27
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Sekiguchi N, Rai S, Munakata W, Suzuki K, Handa H, Shibayama H, Endo T, Terui Y, Iwaki N, Fukuhara N, Tatetsu H, Iida S, Ishikawa T, Shiibashi R, Izutsu K. A multicenter, open-label, phase II study of tirabrutinib (ONO/GS-4059) in patients with Waldenström's macroglobulinemia. Cancer Sci 2020; 111:3327-3337. [PMID: 32639651 PMCID: PMC7469793 DOI: 10.1111/cas.14561] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Tirabrutinib is a second-generation Bruton's tyrosine kinase inhibitor with greater selectivity than ibrutinib. Here, we conducted a multicenter, phase II study of tirabrutinib in patients with treatment-naïve (Cohort A) or with relapsed/refractory (Cohort B) Waldenström's macroglobulinemia (WM). Patients were treated with tirabrutinib 480 mg once daily. The primary endpoint was major response rate (MRR; ≥ partial response). Secondary endpoints included overall response rate (ORR; ≥ minor response), time to major response (TTMR), progression-free survival (PFS), overall survival (OS), and safety. In total, 27 patients (18 in Cohort A; 9 in Cohort B) were enrolled. The median age was 71 y, and the median serum immunoglobulin M level was 3600 mg/dL. Among the patients, 96.2% had the MYD88L265P mutation. MRR and ORR were 88.9% and 96.3%, respectively (Cohort A: MRR, 88.9%; ORR, 94.4%; Cohort B: MRR, 88.9%; ORR, 100%). Median TTMR was 1.87 mo. PFS and OS were not reached with a median follow-up of 6.5 and 8.3 mo for Cohorts A and B, respectively. The most common adverse events (AEs) were rash (44.4%), neutropenia (25.9%), and leukopenia (22.2%), with most AEs classified as grade 1 or 2. Grade ≥ 3 AEs included neutropenia (11.1%), lymphopenia (11.1%), and leukopenia (7.4%). No grade 5 AEs were noted. All bleeding events were grade 1; none were associated with drug-related atrial fibrillation or hypertension. Although the follow-up duration was relatively short, the study met the primary endpoint. Therefore, tirabrutinib monotherapy is considered to be highly effective for both untreated and relapsed/refractory WM with a manageable safety profile. (JapicCTI-173646).
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Affiliation(s)
- Naohiro Sekiguchi
- Department of HematologyNational Hospital Organization Disaster Medical CenterTachikawaJapan
| | - Shinya Rai
- Department of Hematology and RheumatologyFaculty of MedicineKindai UniversityOsakasayamaJapan
| | - Wataru Munakata
- Department of HematologyNational Cancer Center HospitalTokyoJapan
| | - Kenshi Suzuki
- Department of HematologyJapanese Red Cross Medical CenterTokyoJapan
| | - Hiroshi Handa
- Department of HematologyGunma University Graduate School of MedicineMaebashiJapan
| | - Hirohiko Shibayama
- Department of Hematology and OncologyOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoyuki Endo
- Department of HematologyHokkaido University HospitalSapporoJapan
| | - Yasuhito Terui
- Department of Hematology OncologyThe Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Noriko Iwaki
- Department of HematologyKanazawa University HospitalKanazawaJapan
| | - Noriko Fukuhara
- Department of Hematology and RheumatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Hiro Tatetsu
- Department of HematologyKumamoto University HospitalKumamotoJapan
| | - Shinsuke Iida
- Department of Hematology and OncologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Takayuki Ishikawa
- Department of HematologyKobe City Medical Center General HospitalKobeJapan
| | - Ryota Shiibashi
- Department of Clinical DevelopmentOno Pharmaceutical Co., LTD.OsakaJapan
| | - Koji Izutsu
- Department of HematologyNational Cancer Center HospitalTokyoJapan
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28
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Sakurai M, Mori T, Uchiyama H, Ago H, Iwato K, Eto T, Iwasaki H, Kawata T, Takamatsu H, Yamasaki S, Takanashi M, Ichinohe T, Atsuta Y, Suzuki R. Outcome of stem cell transplantation for Waldenström's macroglobulinemia: analysis of the Japan Society for Hematopoietic Cell Transplantation (JSHCT) Lymphoma Working Group. Ann Hematol 2020; 99:1635-1642. [PMID: 32424672 DOI: 10.1007/s00277-020-04078-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Abstract
The role of stem cell transplantation (SCT) for patients with Waldenström's macroglobulinemia (WM) remains undetermined. Therefore, we retrospectively evaluated the outcome of autologous and allogeneic SCT for patients with WM using the registry database of the Japan Society for Hematopoietic Cell Transplantation. Forty-six patients receiving autologous and 31 receiving allogeneic SCT were analyzed. The allogeneic SCT group included more patients with advanced disease status at transplant and received more lines of chemotherapy. The cumulative incidences of non-relapse mortality (NRM) at 1 year were 30.0% (95% CI, 14.7-46.9%) in the allogeneic SCT and 0% in the autologous SCT group. The estimated 3-year overall (OS) and progression-free (PFS) survival rates were 84.5% (95% CI, 66.0-93.4%) and 70.8% (95% CI, 53.0-82.9%) in the autologous SCT group, and 52.2% (95% CI, 32.5-68.6%) and 45.0% (95% CI, 26.3-62.0%) in the allogeneic SCT group. No patients died after the first 2 years following allogeneic SCT. In univariate analyses, disease status at SCT was significantly associated with PFS in autologous SCT, and with OS and PFS in allogeneic SCT. These results suggest that both autologous and allogeneic SCT have each potential role in WM. Allogeneic SCT is more curative for WM, but is associated with high NRM.
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Affiliation(s)
- Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Hiroatsu Ago
- Department of Hematology and Oncology, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Hiromi Iwasaki
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takahito Kawata
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan.,Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Takamatsu
- Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoshi Yamasaki
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Minoko Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Shimane, Japan
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Knauf W, Abenhardt W, Slawik HR, Bückner U, Otremba B, Sauer A, Zahn MO, Wetzel N, Kaiser-Osterhues A, Houet L, Marschner N. Rare lymphomas in routine practice-Treatment and outcome in Waldenström's macroglobulinaemia in the prospective German Tumour Registry Lymphatic Neoplasms. Hematol Oncol 2020; 38:344-352. [PMID: 32383192 PMCID: PMC7497085 DOI: 10.1002/hon.2740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/02/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
Waldenström's macroglobulinaemia (WM) is a rare indolent B‐cell lymphoma for which only little prospective phase III evidence exists. Thus, real world data are important to provide insight into treatment and survival. We present here data on choice and outcome of systemic treatment of patients with WM treated in German routine practice. In total, 139 patients with WM who had been documented in the prospective clinical cohort study Tumour Registry Lymphatic Neoplasms (NCT00889798) were included into this analysis. We analysed the most frequently used first‐line and second‐line treatments between 2009 and 2017 and examined best response, progression‐free survival (PFS) and overall survival (OS). Bendamustine plus rituximab, with a median of six cycles, was by far the most frequently used first‐line treatment (81%). Second‐line treatment was more heterogenous and mainly based on bendamustine, cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP), fludarabine or ibrutinib, the latter approved in 2014. Three‐year PFS from start of first‐line treatment was 83% (95% confidence interval [CI] 74%‐88%), 3‐year OS was 87% (95% CI 80%‐92%). These prospective data give valuable insights into the management and outcome of non‐selected patients with WM treated in German routine practice. In the lack of prospective phase III clinical trials, real world data can help bridging the gap of evidence.
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Affiliation(s)
- Wolfgang Knauf
- Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany
| | | | | | - Ute Bückner
- Hämatologisch-onkologische Schwerpunktpraxis, Bochum, Germany
| | | | - Annette Sauer
- Medizinisches Versorgungszentrum für Blut- und Krebserkrankungen, Potsdam, Germany
| | - Mark-Oliver Zahn
- Medizinisches Versorgungszentrum Onkologische Kooperation, Goslar, Germany
| | - Natalie Wetzel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | - Norbert Marschner
- Praxis für Interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
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30
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How I treat Waldenström macroglobulinemia. Blood 2020; 134:2022-2035. [PMID: 31527073 DOI: 10.1182/blood.2019000725] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
Waldenström macroglobulinemia (WM) is an uncommon lymphoma characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M (IgM). The disease may have an asymptomatic phase, or patients may present with symptoms and complications resulting from marrow or other tissue infiltration, or from physicochemical or immunological properties of the monoclonal IgM. Diagnosis of WM has been clearly defined, and genetic testing for somatic mutation of MYD88L265P is a useful tool for differential diagnosis from other conditions. Specific criteria that define symptomatic disease that needs treatment offer clinical guidance. The treatment of WM has evolved rapidly, with treatment options that include anti-CD20 monoclonal antibody-based combinations and BTK inhibitors. The choice of therapy is based on the need for rapid disease control, presence of specific disease complications, and patient's age. With the use of BTK inhibitors, the use of continuous therapy has been introduced as another option over fixed-duration chemoimmunotherapy. In this review, we focus on different clinical scenarios and discuss treatment options, based on the available data.
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Abstract
Waldenstrom macroglobulinemia (WM) is a lymphoplasmacytic lymphoma that presents with symptomatic anemia, thrombocytopenia, constitutional symptoms, extramedullary disease and rarely hyperviscosity syndrome. The presence of both IgM monoclonal protein and ≥10% monoclonal lymphoplasmacytic cells is required for the diagnosis. MyD88 is present in 67-90% of patients but is not pathognomonic for WM. Many patients who fulfill the criteria of WM are asymptomatic and do not require treatment. Recent advances in the understanding of the biology of WM have paved the way for new treatment options. The use of novel agents with or without rituximab enables the use of effective chemotherapy-free regiments upfront and in the relapsed setting. New targeted treatments such as venetoclax and CXCR4 antagonists are being investigated.
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Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah- Tikva, Israel.,Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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32
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Sekiguchi N, Hamano A, Kitagawa T, Ito K, Hirano K, Yamada K. What is the most appropriate regimen for untreated Waldenström macroglobulinemia? - An updated analysis of rituximab and half-dose CHOP therapy and cost effectiveness. Blood Res 2019; 54:153-156. [PMID: 31309097 PMCID: PMC6614101 DOI: 10.5045/br.2019.54.2.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Naohiro Sekiguchi
- Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.,Clinical Research Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Airi Hamano
- Pharmaceutical Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tomoko Kitagawa
- Clinical Research Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kenichi Ito
- Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazuhiko Hirano
- Laboratory and Pathology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazuaki Yamada
- Laboratory and Pathology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan
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33
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A revised international prognostic score system for Waldenström's macroglobulinemia. Leukemia 2019; 33:2654-2661. [PMID: 31118465 DOI: 10.1038/s41375-019-0431-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/27/2019] [Accepted: 01/31/2019] [Indexed: 01/19/2023]
Abstract
A staging system was developed a decade ago for patients with Waldenström's macroglobulinemia (WM), however, since then WM treatments have changed. A revised staging system could better capture prognosis of WM patients in the chemoimmunotherapy era. We developed a revised system based on data from 492 symptomatic patients with at least 3 years and a median of 7 years of follow up while an independent validation cohort included 229 symptomatic patients. We identified age (≤65 vs 66-75 vs ≥76 years), b2-microglobulin ≥ 4 mg/L, serum albumin <3.5 gr/dl, and LDH ≥ 250 IU/L (ULN < 225) to stratify patients in five different prognostic groups and identify a very-low risk as well as a very-high risk group with a 3-year WM-related death rate of 0, 10, 14, 38, and 48% (p < 0.001) and 10-year survival rate of 84, 59, 37, 19, and 9% (p < 0.001). We evaluated this staging system separately in patients >65 years and <65 years, according to the reason for initiation of treatment, among patients receiving frontline rituximab or in patients treated primarily without rituximab. With further validation before clinical use, this revised IPSSWM could improve WM patient risk stratification, is easily available and may be used in the everyday practice to provide prognostic information.
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34
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Treon SP, Castillo JJ. The real world of Waldenström's macroglobulinaemia. LANCET HAEMATOLOGY 2018; 5:e275-e276. [PMID: 29958567 DOI: 10.1016/s2352-3026(18)30091-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Steven P Treon
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
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35
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