Bendamustine and rituximab (BR) versus dexamethasone, rituximab, and cyclophosphamide (DRC) in patients with Waldenström macroglobulinemia

Jonas Paludo, Jithma P. Abeykoon, Amanda Shreders, Stephen Maxted Ansell, Shaji K Kumar, Sikander Ailawadhi, Rebecca King, Amber B. Koehler, Craig B. Reeder, Francis K. Buadi, Angela Dispenzieri, Martha Lacy, David M Dingli, Thomas Elmer Witzig, Ronald S. Go, Wilson Gonsalves, Taxiarchis Kourelis, Rahma Warsame, Nelson Leung, Thomas Matthew HabermannSuzanne Hayman, Yi Lin, Robert A. Kyle, S Vincent Rajkumar, Morie Gertz, Prashant Kapoor

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9 Citations (Scopus)

Abstract

The treatment approaches for Waldenstrom macroglobulinemia (WM) are largely based upon information from single-arm phase II trials, without comparative data. We compared the efficacy of two commonly used regimens in routine practice (bendamustine-rituximab (BR) and dexamethasone, rituximab plus cyclophosphamide (DRC)) and evaluated their activity with respect to the patients’ MYD88L265P mutation status. Of 160 consecutive patients, 60 received BR (43 with relapsed/refractory WM) and 100 received DRC (50 had relapsed/refractory WM). In the treatment-naïve setting, overall response rate (ORR) was 93% with BR versus 96% with DRC (p = 0.55). Two-year progression-free survival (PFS) with BR and DRC was 88 and 61%, respectively (p = 0.07). In salvage setting, ORR was 95% with BR versus 87% with DRC, p = 0.45; median PFS with BR was 58 versus 32 months with DRC (2-year PFS was 66 versus 53%; p = 0.08). Median disease-specific survival was not reached with BR versus 166 months with DRC (p = 0.51). The time-to-event endpoints and depth of response were independent of the MYD88 mutation status. Grade ≥ 3 adverse events of both regimens were comparable. A trend for longer PFS was observed with BR although the regimens have comparable toxicities. The activity of BR and DRC appears to be unaffected by patients’ MYD88 mutation status.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Hematology
DOIs
StateAccepted/In press - Apr 3 2018

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Waldenstrom Macroglobulinemia
Cyclophosphamide
Dexamethasone
Disease-Free Survival
Bendamustine Hydrochloride
Rituximab
Mutation

Keywords

  • Drug therapy
  • Immunoglobulin M
  • Lymphoma
  • Lymphoplasmacytic lymphoma
  • MYD88

ASJC Scopus subject areas

  • Hematology

Cite this

@article{ac24d7c0b83049f8a03497a38c971490,
title = "Bendamustine and rituximab (BR) versus dexamethasone, rituximab, and cyclophosphamide (DRC) in patients with Waldenstr{\"o}m macroglobulinemia",
abstract = "The treatment approaches for Waldenstrom macroglobulinemia (WM) are largely based upon information from single-arm phase II trials, without comparative data. We compared the efficacy of two commonly used regimens in routine practice (bendamustine-rituximab (BR) and dexamethasone, rituximab plus cyclophosphamide (DRC)) and evaluated their activity with respect to the patients’ MYD88L265P mutation status. Of 160 consecutive patients, 60 received BR (43 with relapsed/refractory WM) and 100 received DRC (50 had relapsed/refractory WM). In the treatment-na{\"i}ve setting, overall response rate (ORR) was 93{\%} with BR versus 96{\%} with DRC (p = 0.55). Two-year progression-free survival (PFS) with BR and DRC was 88 and 61{\%}, respectively (p = 0.07). In salvage setting, ORR was 95{\%} with BR versus 87{\%} with DRC, p = 0.45; median PFS with BR was 58 versus 32 months with DRC (2-year PFS was 66 versus 53{\%}; p = 0.08). Median disease-specific survival was not reached with BR versus 166 months with DRC (p = 0.51). The time-to-event endpoints and depth of response were independent of the MYD88 mutation status. Grade ≥ 3 adverse events of both regimens were comparable. A trend for longer PFS was observed with BR although the regimens have comparable toxicities. The activity of BR and DRC appears to be unaffected by patients’ MYD88 mutation status.",
keywords = "Drug therapy, Immunoglobulin M, Lymphoma, Lymphoplasmacytic lymphoma, MYD88",
author = "Jonas Paludo and Abeykoon, {Jithma P.} and Amanda Shreders and Ansell, {Stephen Maxted} and Kumar, {Shaji K} and Sikander Ailawadhi and Rebecca King and Koehler, {Amber B.} and Reeder, {Craig B.} and Buadi, {Francis K.} and Angela Dispenzieri and Martha Lacy and Dingli, {David M} and Witzig, {Thomas Elmer} and Go, {Ronald S.} and Wilson Gonsalves and Taxiarchis Kourelis and Rahma Warsame and Nelson Leung and Habermann, {Thomas Matthew} and Suzanne Hayman and Yi Lin and Kyle, {Robert A.} and Rajkumar, {S Vincent} and Morie Gertz and Prashant Kapoor",
year = "2018",
month = "4",
day = "3",
doi = "10.1007/s00277-018-3311-z",
language = "English (US)",
pages = "1--9",
journal = "Annals of Hematology",
issn = "0939-5555",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Bendamustine and rituximab (BR) versus dexamethasone, rituximab, and cyclophosphamide (DRC) in patients with Waldenström macroglobulinemia

AU - Paludo, Jonas

AU - Abeykoon, Jithma P.

AU - Shreders, Amanda

AU - Ansell, Stephen Maxted

AU - Kumar, Shaji K

AU - Ailawadhi, Sikander

AU - King, Rebecca

AU - Koehler, Amber B.

AU - Reeder, Craig B.

AU - Buadi, Francis K.

AU - Dispenzieri, Angela

AU - Lacy, Martha

AU - Dingli, David M

AU - Witzig, Thomas Elmer

AU - Go, Ronald S.

AU - Gonsalves, Wilson

AU - Kourelis, Taxiarchis

AU - Warsame, Rahma

AU - Leung, Nelson

AU - Habermann, Thomas Matthew

AU - Hayman, Suzanne

AU - Lin, Yi

AU - Kyle, Robert A.

AU - Rajkumar, S Vincent

AU - Gertz, Morie

AU - Kapoor, Prashant

PY - 2018/4/3

Y1 - 2018/4/3

N2 - The treatment approaches for Waldenstrom macroglobulinemia (WM) are largely based upon information from single-arm phase II trials, without comparative data. We compared the efficacy of two commonly used regimens in routine practice (bendamustine-rituximab (BR) and dexamethasone, rituximab plus cyclophosphamide (DRC)) and evaluated their activity with respect to the patients’ MYD88L265P mutation status. Of 160 consecutive patients, 60 received BR (43 with relapsed/refractory WM) and 100 received DRC (50 had relapsed/refractory WM). In the treatment-naïve setting, overall response rate (ORR) was 93% with BR versus 96% with DRC (p = 0.55). Two-year progression-free survival (PFS) with BR and DRC was 88 and 61%, respectively (p = 0.07). In salvage setting, ORR was 95% with BR versus 87% with DRC, p = 0.45; median PFS with BR was 58 versus 32 months with DRC (2-year PFS was 66 versus 53%; p = 0.08). Median disease-specific survival was not reached with BR versus 166 months with DRC (p = 0.51). The time-to-event endpoints and depth of response were independent of the MYD88 mutation status. Grade ≥ 3 adverse events of both regimens were comparable. A trend for longer PFS was observed with BR although the regimens have comparable toxicities. The activity of BR and DRC appears to be unaffected by patients’ MYD88 mutation status.

AB - The treatment approaches for Waldenstrom macroglobulinemia (WM) are largely based upon information from single-arm phase II trials, without comparative data. We compared the efficacy of two commonly used regimens in routine practice (bendamustine-rituximab (BR) and dexamethasone, rituximab plus cyclophosphamide (DRC)) and evaluated their activity with respect to the patients’ MYD88L265P mutation status. Of 160 consecutive patients, 60 received BR (43 with relapsed/refractory WM) and 100 received DRC (50 had relapsed/refractory WM). In the treatment-naïve setting, overall response rate (ORR) was 93% with BR versus 96% with DRC (p = 0.55). Two-year progression-free survival (PFS) with BR and DRC was 88 and 61%, respectively (p = 0.07). In salvage setting, ORR was 95% with BR versus 87% with DRC, p = 0.45; median PFS with BR was 58 versus 32 months with DRC (2-year PFS was 66 versus 53%; p = 0.08). Median disease-specific survival was not reached with BR versus 166 months with DRC (p = 0.51). The time-to-event endpoints and depth of response were independent of the MYD88 mutation status. Grade ≥ 3 adverse events of both regimens were comparable. A trend for longer PFS was observed with BR although the regimens have comparable toxicities. The activity of BR and DRC appears to be unaffected by patients’ MYD88 mutation status.

KW - Drug therapy

KW - Immunoglobulin M

KW - Lymphoma

KW - Lymphoplasmacytic lymphoma

KW - MYD88

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U2 - 10.1007/s00277-018-3311-z

DO - 10.1007/s00277-018-3311-z

M3 - Article

C2 - 29610969

AN - SCOPUS:85044712052

SP - 1

EP - 9

JO - Annals of Hematology

JF - Annals of Hematology

SN - 0939-5555

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