TY - JOUR
T1 - Dexamethasone, rituximab and cyclophosphamide for relapsed and/or refractory and treatment-naïve patients with Waldenstrom macroglobulinemia
AU - Paludo, Jonas
AU - Abeykoon, Jithma P.
AU - Kumar, Shaji
AU - Shreders, Amanda
AU - Ailawadhi, Sikander
AU - Gertz, Morie A.
AU - Kourelis, Taxiarchis
AU - King, Rebecca L.
AU - Reeder, Craig B.
AU - Leung, Nelson
AU - Kyle, Robert A.
AU - Buadi, Francis K.
AU - Habermann, Thomas M.
AU - Dingli, David
AU - Witzig, Thomas E.
AU - Dispenzieri, Angela
AU - Lacy, Martha Q.
AU - Go, Ronald S.
AU - Lin, Yi
AU - Gonsalves, Wilson I.
AU - Warsame, Rahma
AU - Lust, John A.
AU - Rajkumar, S. Vincent
AU - Ansell, Stephen M.
AU - Kapoor, Prashant
N1 - Funding Information:
Dr Kumar has received honoraria from Skyline Diagnostics. Research support from Abbvie, Celgene, Novartis, Amgen, Takeda, Sanofi and Janssen has been provided to the Institution for conduct of clinical trials on which Dr Kumar serves as a principal investigator. Dr Ailawadhi has served as a consultant for Novartis Pharmaceuticals, Amgen Pharmaceuticals, Pharmacyclics, Inc, and Takeda, and has received research funding from Pharmacyclics, Inc. Dr Gertz has received research support from Ionis Pharmaceuticals and Prothena and honoraria from Celgene, Millennium Pharmaceuticals and Novartis. Dr Reeder has received research support from Celgene, Novartis and Millennium. No other disclosures are reported. Dr Dingli has received research funding from Takeda, Karyopharm and Amgen. Dr Witzig reports receiving research funding from Celgene (Institution), Novartis (Institution), Spectrum Pharmaceuticals (Institution) and Acerta Pharma (Institution). Dr Dispenzieri has received research support from Celgene, Millenium, Pfizer, Jannsen and Alnylam. Dr Lacy receives research funding from Celgene. Dr Lin receives research funding from Janssen. Dr Ansell has received research funding from Bristol-Myers Squibb, Celldex, Merck, Affimed and Seattle Genetics. Dr Kapoor has received research funding from Takeda (Institution), Onyx (Institution) and Celgene (Institution), and consulting fees from Celgene and Sanofi (Institution).
Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2017/10
Y1 - 2017/10
N2 - The management of Waldenström macroglobulinaemia (WM) relies predominantly on small trials, one of which has demonstrated activity of dexamethasone, rituximab and cyclophosphamide (DRC) in the frontline setting. We report on the efficacy of DRC, focusing on relapsed/refractory (R/R) patients. Ibrutinib, a recently approved agent in WM demonstrated limited activity in patients with MYD88WT genotype. Herein, we additionally report on the activity of DRC based on the MYD88L265P mutation status. Of 100 WM patients evaluated between January 2007 and December 2014 who received DRC, 50 had R/R WM. The overall response rate (ORR) was 87%. The median progression-free survival (PFS) and time-to-next-therapy (TTNT) were 32 (95% confidence interval [CI]: 15–51) and 50 (95% CI: 35–60) months, respectively. In the previously untreated cohort (n = 50), the ORR was 96%, and the median PFS and TTNT were 34 months (95% CI: 23–not reached [NR]) and NR (95% CI: 37–NR), respectively. Twenty-five (86%) of 29 genotyped patients harbored MYD88L265P. The response rates and outcomes were independent of MYD88 mutation status. Grade ≥3 adverse effects included neutropenia (20%), thrombocytopenia (7%) and infections (3%). Similar to the frontline setting, DRC is an effective and well-tolerated salvage regimen for WM. In contrast to ibrutinib, DRC offers a less expensive, fixed-duration option, with preliminary data suggesting efficacy independent of the patients’ MYD88 status.
AB - The management of Waldenström macroglobulinaemia (WM) relies predominantly on small trials, one of which has demonstrated activity of dexamethasone, rituximab and cyclophosphamide (DRC) in the frontline setting. We report on the efficacy of DRC, focusing on relapsed/refractory (R/R) patients. Ibrutinib, a recently approved agent in WM demonstrated limited activity in patients with MYD88WT genotype. Herein, we additionally report on the activity of DRC based on the MYD88L265P mutation status. Of 100 WM patients evaluated between January 2007 and December 2014 who received DRC, 50 had R/R WM. The overall response rate (ORR) was 87%. The median progression-free survival (PFS) and time-to-next-therapy (TTNT) were 32 (95% confidence interval [CI]: 15–51) and 50 (95% CI: 35–60) months, respectively. In the previously untreated cohort (n = 50), the ORR was 96%, and the median PFS and TTNT were 34 months (95% CI: 23–not reached [NR]) and NR (95% CI: 37–NR), respectively. Twenty-five (86%) of 29 genotyped patients harbored MYD88L265P. The response rates and outcomes were independent of MYD88 mutation status. Grade ≥3 adverse effects included neutropenia (20%), thrombocytopenia (7%) and infections (3%). Similar to the frontline setting, DRC is an effective and well-tolerated salvage regimen for WM. In contrast to ibrutinib, DRC offers a less expensive, fixed-duration option, with preliminary data suggesting efficacy independent of the patients’ MYD88 status.
KW - IgM monoclonal gammopathy
KW - MYD88
KW - indolent lymphoma
UR - http://www.scopus.com/inward/record.url?scp=85029798884&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85029798884&partnerID=8YFLogxK
U2 - 10.1111/bjh.14826
DO - 10.1111/bjh.14826
M3 - Article
C2 - 28786474
AN - SCOPUS:85029798884
SN - 0007-1048
VL - 179
SP - 98
EP - 105
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 1
ER -