Bendamustine and Ofatumumab for Waldenström’s – pro

Waldenström’s macroglobulinemia (WM) is a CD20 expressing B-cell malignancy represented by the pathological diagnosis of IgM secreting lymphoplasmacytic lymphoma. Since 1999, there have been many reprts and several  phase II studies of Rituxan in this disease. Major response rates of 30% have been reported in most studies with standard dose rituximab, i.e. 4 weekly infusions at 375 mg/m2/week.  A recent guideline states: “Rituximab is active in the treatment of WM but associated with the risk of transient exacerbation of clinical effects of the disease and should only be used with caution especially in patients with symptoms of hyperviscosity and/or IgM levels > 40g/L. Level of evidence IIb, Grade of recommendation B.”

NCCN recommends a number of regimens, amongst them bendamustine and Rituxan and ofatumumab as a single agent. However, combination of ofatumumab and bendamustine is still investigational. There are several phase 2 clinical trials in different conditions but not currently in Waldenström’s.

A. Vijay and M. A. Gertz
Waldenstrom macroglobulinemia
Blood, June 15, 2007; 109(12): 5096 – 5103.

Johnson SA, Birchall J, Luckie C, Oscier DG, Owen RG, Haemato-Oncology Task Force of the British Committee for Standards in Haematology. Guidelines on the management of Waldenstrom macroglobulinaemia. Br J Haematol 2006 Mar;132(6):683-97. [108 references]

Treon SP, Hanzis C, Tripsas C, Ioakimidis L, Patterson CJ, Manning RJ, Sheehy P. Bendamustine therapy in patients with relapsed or refractory Waldenström’s macroglobulinemia.Clin Lymphoma Myeloma Leuk. 2011 Feb;11(1):133-5.

Victorian, Brande. Managing Waldenström’s Macroglobulinemia in the Face of Limited Data and Experience
Oncology Times: 10 November 2010 – Volume 32 – Issue 21 – pp 47-49

NCCN, Waldenstrom’s MPLP-B

Read the Layperson version here.

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