Waldenström's macroglobulinemia (WM)

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Presentation transcript:

Waldenström's macroglobulinemia (WM) Treatment pathway Waldenström's macroglobulinemia (WM) Author: Dr Nagesh Kalakonda, Consultant Haematologist, on behalf of the Haematology CNG Written: March 2011 Agreed by CNG: April 2011 Review Due: April 2012 References: 1. NEPARIDZE, N., DHODAPKAR. M. (2009) Waldenstrom’s Macroglobulinemia: Recent Advances in Biology and Therapy; Clinical Advances in Hematology & Oncology Volume 7, Issue 10, October 2009 677 -690 2. TREON.S, (2009) How I treat Waldenström macroglobulinemia BLOOD, 17 September 2009 Volume 114, Number 12, 2375-2385 3. DIMOPOULOS M ,GERTZ M, KASTRITIS E et al (2008) Update on Treatment Recommendations From the Fourth International Workshop on Waldenstrom’s Macroglobulinemia; Journal of Clinical Oncology; published online http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2008.17.7865 Page 1 of 2

Consider plasmapheresis Asymptomatic Observation q2-3 mths yr 1 q3-6 mths > yr 1 WM Progression Symptomatic ASCT ineligible Single agent Chl., F, or Cladribine ASCT eligible Progression R-CP or R-CD or R-CVP or R-CHOP # Progression Progression Re-use R-CP or R-CD or R-CVP or R-CHOP if ≥ 2 years BDR* or R-Bendamustine or R-Thalidomide (If no history or evidence of VTE) Progression Progression Consider Campath Progression Consider plasmapheresis at all stages Salvage + ASCT** Chl. – Chlorambucil, C – Cyclophosphamide, R – Rituximab, F – Fludarabine P – Prednisolone, D – Dexamethasone, H – Doxorubucin, VTE – Venous Thrombo-embolism # R may cause IgM flare which can last a few months. May need to consider omitting for 1 -2 courses *BDR – Bortezomib + Dexamethasone + Rituximab (Particularly useful for rapid reduction of IgM levels). Funding requests for 2 cycle blocks (to a maximum of 8 cycles) subject to demonstration of objective and ongoing response(s). ** May need to be considered earlier in the pathway in the event of rapid progression + younger age or high grade transformation. An allograft may be considered in very select situations. MCCN WM treatment pathway, April 2011 (due for review April 2012) Page 2 of 2