Waldenström’s macroglobulinemia (WM) is a disease which produces CD20 antibodies and which corresponds to a pathological diagnosis of IgM secreting lymphoplasmacytic lymphoma. Since 1999, there have been many reports 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 with ofatumumab as a single agent. However, combination of ofatumumab and bendamustine is still investigational. There are several phase 2 clinical trials of this combination in different conditions but not currently in Waldenström’s.
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