Waldenström's macroglobulinemia medical therapy: Difference between revisions

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*Constitutional symptoms
*Constitutional symptoms


'''Treatment regimen used:'''<ref name="PHARM">Waldenström's macroglobulinemia. Medscape (2015)http://emedicine.medscape.com/article/2057687-overview Accessed on November 11, 2015</ref><ref name="ADR">Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015</ref>
'''Treatment:'''<ref name="PHARM">Waldenström's macroglobulinemia. Medscape (2015)http://emedicine.medscape.com/article/2057687-overview Accessed on November 11, 2015</ref><ref name="ADR">Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015</ref>


*'''CHOP-R regimen''':
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px"
:*Cyclophosphamide  
|valign=top|
:*Doxorubicin  
|+
:*Vincristine
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Treatment Regimen}}
:*Prednisone  
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Drugs}}
:*Rituximab  
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Side effects}}
*'''Adverse Effect:'''
|-
:*Nausea
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:*Alopecia
'''CHOP-R regimen'''  
:*Granulocytopenia
| style="padding: 5px 5px; background: #F5F5F5;" |
 
*Cyclophosphamide
'''Ibrutinib''' 420 mg PO once daily until disease progression
*Doxorubicin
::*'''Adverse Effect:'''
*Vincristine
:::*Fatigue
*Prednisone
:::*Cytopenia
*Rituximab
 
| style="padding: 5px 5px; background: #F5F5F5;" |
'''Rituximab''' 375 mg/m2 IV once weekly x 4 weeks
*Nausea
::*'''Adverse Effect:'''
*Alopecia
:::*Infusion related reaction
*Granulocytopenia
:::*Infections
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Fludarabine/Rituximab regimen:'''
'''Ibrutinib'''
*Fludarabine 25 mg/m2 IV days 1-5;
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rituximab 375 mg/m2 IV day 1;
*Ibrutinib
*Repeat 28 day cycle for 4-6 cycles
| style="padding: 5px 5px; background: #F5F5F5;" |
::*'''Adverse Effect:'''
*Fatigue
:::*Neutropenia (63%)
*Cytopenia
:::*Thrombocytopenia
|-
:::*Pneumonia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
 
'''Rituximab'''
'''FCR regimen:'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Fludarabine 25 mg/m2 IV days 1-3
*Rituximab
*Cyclophosphamide 250 mg/m2 IV days 1-3
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rituximab 375 mg/m2 IV day 1
*Infusion related reaction
*Primary: Repeat 28 day cycle for 4-6 cycles
*Infections
*May also be given with mitoxantrone 10 mg/m2 on day 1
|-
::*'''Adverse Effect:'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:::*Neurtropenia
'''FR regimen'''
 
| style="padding: 5px 5px; background: #F5F5F5;" |
'''BR regimen:'''
*Fludarabine
*Bendamustine 90 mg/m2 IV days 1-2
*Rituximab
*Rituximab 375 mg/m2 IV day 1
| style="padding: 5px 5px; background: #F5F5F5;" |
*Primary: Repeat 21 day cycle for 6 cycles
*Neutropenia (63%)
::*'''Adverse Effect:'''
*Thrombocytopenia
:::*Myelosupression
*Pneumonia
:::*Neutropenia
|-
:::*Thrombocytopenia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
 
'''BDR regimen'''
'''BDR regimen:'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Bortezomib 1.3 mg/m2plus
*Bortezomib
*Dexamethasone 40 mg IV days 1, 4, 8, and 11
*Dexamethasone
*Rituximab 375 mg/m2 IV day 11
*Rituximab
*Primary: Repeat 21 day cycle for 4 cycles
| style="padding: 5px 5px; background: #F5F5F5;" |
::*'''Adverse Effect:'''
*Peripheral Neuropathy - reversible in 61% of patients
:::*Peripheral neuropathy - reversible in 61% of patients
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''DRC regimen:'''
'''DRC regimen'''
*Dexamethasone 20 mg IV day 1
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rituximab 375 mg/m2 IV day 1
*Dexamethasone
*Cyclophosphamide 100 mg/m2 PO BID days 1-5
*Rituximab
*Primary: Repeat 21 day cycle for 6 cycles
*Cyclophosphamide
::*'''Adverse Effect:'''
| style="padding: 5px 5px; background: #F5F5F5;" |
:::*Neutropenia
*Neutropenia
:::*Rituximab associated toxicity
|-
 
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''CR regimen:'''
'''CR regimen'''
*Cladribine 0.1 mg/kg SC days 1-5
| style="padding: 5px 5px; background: #F5F5F5;" |
*Rituximab 375 mg/m2 IV day 1
*Cladribine
*Primary: Repeat 28 day cycle for 4 cycles
*Rituximab
::*'''Adverse Effect:'''
| style="padding: 5px 5px; background: #F5F5F5;" |
:::*Anemia
*Anemia
:::*Neurological symptoms
*Neurological symptoms
:::*symptomatic cryoglobulinemia
*Symptomatic cryoglobulinemia
:::*Thrombocytopenia
*Thrombocytopenia
|-
|}


===Hyperviscosity syndrome===
===Hyperviscosity syndrome===

Revision as of 18:34, 17 November 2015

Waldenström's macroglobulinemia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]

Overview

Risk stratification determines the protocol of management used for Waldenström's macroglobulinemia patients. Watchful waiting is recommended for asymptomatic Waldenström's macroglobulinemia. Symptomatic Waldenström's macroglobulinemia is treated with Rituximab +/- Chemotherapy.[1]

Medical Therapy

There are several different options for Waldenström Macroglobulinemia.[2]

Asymptomatic/Smoldering Waldenström's macroglobulinemia

Patients who do not have symptoms and whose cancer does not seem to be progressing often do not need treatment. They can be monitored every 3-6 months - a 'wait and watch approach'.[3]

Symptomatic Waldenström's macroglobulinemia

Symptomatic patients with Waldenström Macroglobulinemia are started on chemotherapy depending on the stage.[1]

Initial stage of Waldenström's macroglobulinemia associated with

  • Neuropathy,
  • Anemia or cytopenias,
  • Low-volume nodal involvement, and
  • Asymptomatic splenomegaly

Treatment: Single-agent Rituximab therapy

Late stage of Waldenström's macroglobulinemia associated with

  • Adenopathy,
  • Symptomatic splenomegaly,
  • Cytopenias,
  • Hyperviscosity syndrome,
  • Neuropathy, or
  • Constitutional symptoms

Treatment:[1][4]

Treatment Regimen Drugs Side effects

CHOP-R regimen

  • Cyclophosphamide
  • Doxorubicin
  • Vincristine
  • Prednisone
  • Rituximab
  • Nausea
  • Alopecia
  • Granulocytopenia

Ibrutinib

  • Ibrutinib
  • Fatigue
  • Cytopenia

Rituximab

  • Rituximab
  • Infusion related reaction
  • Infections

FR regimen

  • Fludarabine
  • Rituximab
  • Neutropenia (63%)
  • Thrombocytopenia
  • Pneumonia

BDR regimen

  • Bortezomib
  • Dexamethasone
  • Rituximab
  • Peripheral Neuropathy - reversible in 61% of patients

DRC regimen

  • Dexamethasone
  • Rituximab
  • Cyclophosphamide
  • Neutropenia

CR regimen

  • Cladribine
  • Rituximab
  • Anemia
  • Neurological symptoms
  • Symptomatic cryoglobulinemia
  • Thrombocytopenia

Hyperviscosity syndrome

  • Plasmapheresis is recommended emergent treatment option for patients with Waldenström Macroglobulinemia who develop hyperviscosity symptoms.[1]
  • Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes the blood thinner.
  • However, plasmapheresis does not affect the lymphoma cells.
  • Plasmapheresis is usually given until chemotherapy starts to work.
  • Plasmapheresis is combined with chemotherapy to control the disease for a longer period of time.

Salvage approach

  • Stem cell transplant is used in patients whose lymphoma relapses or is not responding to other treatments (refractory). [1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Waldenström's macroglobulinemia. Medscape (2015)http://emedicine.medscape.com/article/2057687-overview Accessed on November 11, 2015
  2. ↑ Lymphoplasmacytic lymphoma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/lymphoplasmacytic-lymphoma/?region=ab Accessed on November 6 2015
  3. ↑ Waldenström's macroglobulinemia. Patient (2015)http://patient.info/doctor/waldenstroms-macroglobulinaemia-pro Accessed on November 10, 2015
  4. ↑ Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015

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