Originally published as JCO Early Release 10.1200/JCO.2008.17.7865 on December 1 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dimopoulos, M. A. Articles by Treon, S. P. Search for Related Content PubMed PubMed Citation Articles by Dimopoulos, M. A. Articles by Treon, S. P. Social Bookmarking                            What's this?

Update on Treatment Recommendations From the Fourth International Workshop on Waldenström's Macroglobulinemia

Meletios Athanasios Dimopoulos, Morie A. Gertz, Efstathios Kastritis, Ramon Garcia-Sanz, Eva K. Kimby, Veronique LeBlond, Jean-Paul Fermand, Giampaolo Merlini, Pierre Morel, Enrica Morra, Enrique M. Ocio, Roger Owen, Irene M. Ghobrial, John Seymour, Robert A. Kyle, Steven P. Treon

From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine, Rochester, MN; Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and Department of Hematology, Peter MacCallum Cancer Center and University of Melbourne, Melbourne, Victoria, Australia

Corresponding author: Meletios A. Dimopoulos, MD, Department of Clinical Therapeutics, University of Athens, School of Medicine, Alexandra Hospital, 80 Vas Sofias, Athens 11528, Greece; e-mail: mdimop{at}med.uoa.gr

Waldenström macroglobulinemia (WM) is a distinct B-cell lymphoproliferative disorder characterized by lymphoplasmacytic bone marrow infiltration along with an immunoglobulin M (IgM) monoclonal gammopathy. Patients with disease-related cytopenias, bulky adenopathy or organomegaly, symptomatic hyperviscosity, severe neuropathy, amyloidosis, cryoglobulinemia, cold agglutinin disease, or evidence of disease transformation should be considered for immediate therapy. Initiation of therapy should not be based on serum IgM levels alone, and asymptomatic patients should be observed. Individual patient considerations should be considered when deciding on a first-line agent including the presence of cytopenias, need for rapid disease control, age, and candidacy for autologous transplantation. Therapeutic outcomes should be evaluated using updated criteria. As part of the Fourth International Workshop on Waldenström's Macroglobulinemia, a consensus panel updated its recommendations on both first-line and salvage therapy in view of recently published and ongoing clinical trials. The panel considered encouraging results from recent studies of first-line combinations such as rituximab with nucleoside analogs with or without alkylating agents or with cyclophosphamide-based therapies (eg, cyclophosphamide, doxorubicin, vincristine, and prednisone or cyclophosphamide and dexamethasone) or the combination of rituximab with thalidomide. Such therapeutic approaches are likely to yield responses at least as good as, if not better than, monotherapy with any of the alkylating agents, nucleoside analogs, or rituximab. In the salvage setting, reuse of a first-line regimen or use of a different regimen should be considered along with bortezomib, alemtuzumab, autologous transplantation, and, in selected circumstances, allogeneic transplantation. Finally, the panel reaffirmed its encouragement of the active enrollment of patients with WM onto innovative clinical trials whenever possible.

published online ahead of print at www.jco.org on December 1, 2008

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				R. L. Comenzo How I treat amyloidosis Blood, October 8, 2009; 114(15): 3147 - 3157. [Abstract] [Full Text] [PDF]

				S. P. Treon How I treat Waldenstrom macroglobulinemia Blood, September 17, 2009; 114(12): 2375 - 2385. [Abstract] [Full Text] [PDF]

				S. P. Treon, L. Ioakimidis, J. D. Soumerai, C. J. Patterson, P. Sheehy, M. Nelson, M. Willen, J. Matous, J. Mattern II, J. G. Diener, et al. Primary Therapy of Waldenstrom Macroglobulinemia With Bortezomib, Dexamethasone, and Rituximab: WMCTG Clinical Trial 05-180 J. Clin. Oncol., August 10, 2009; 27(23): 3830 - 3835. [Abstract] [Full Text] [PDF]

				A. Delmonte, M. Ghielmini, and C. Sessa Beyond Monoclonal Antibodies: New Therapeutic Agents in Non-Hodgkin's Lymphomas Oncologist, May 1, 2009; 14(5): 511 - 525. [Abstract] [Full Text] [PDF]

				S. P. Treon, A. R. Branagan, L. Ioakimidis, J. D. Soumerai, C. J. Patterson, B. Turnbull, P. Wasi, C. Emmanouilides, S. R. Frankel, A. Lister, et al. Long-term outcomes to fludarabine and rituximab in Waldenstrom macroglobulinemia Blood, April 16, 2009; 113(16): 3673 - 3678. [Abstract] [Full Text] [PDF]