Initial immunoglobulin M 'Flare' after rituximab therapy in patients diagnosed with Waldenstrom macroglobulinemia: An Eastern Cooperative Oncology Group Study

Irene M. Ghobrial, Rafael Fonseca, Philip R. Greipp, Emily Blood, Montserrat Rue, David H. Vesole, Morie Gertz

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

BACKGROUND. The goal of the current study was to characterize the initial upsurge in immunoglobulin M (IgM) levels after treatment with rituximab in patients with Waldenstrom macroglobulinemia (WM). METHODS. As part of a Phase II Eastern Cooperative Oncology Group study, 72 patients were treated with rituximab (375 mg/m2 weekly for 4 weeks) between April 2000 and January 2002. IgM levels in these patients vvere measured at five separate time points so that any temporal changes that occurred could be characterized. RESULTS. Of the 54 patients for whom the relevant IgM measurements were available, 29 (54%) experienced an increase in IgM levels between baseline and the first scheduled postbaseline time point. At 2 months, 13 of 22 evaluable patients (59%) continued to have elevated IgM levels, and at 4 months, elevated IgM levels persisted in 4 of 15 evaluable patients (27%). Overall, a nonlinear trend characterized by an initial increase in IgM levels followed by a decrease in these levels was observed (P < 0.0001). CONCLUSIONS. Treating physicians should be aware that an IgM 'flare' may occur in up to 54% of patients treated with rituximab; however, most of these patients experience a decrease in IgM levels within 4 months after the initiation of therapy. Therefore, patients should not be discouraged from continuing to receive this potentially effective therapeutic agent, as responses to rituximab may develop slowly. Longer follow-up will reveal whether patients who experience an upsurge in IgM levels have poorer overall survival or shorter times to progression compared with patients who do not experience this IgM flare. Factors predicting an initial increase in IgM levels could not be identified.

Original languageEnglish (US)
Pages (from-to)2593-2598
Number of pages6
JournalCancer
Volume101
Issue number11
DOIs
StatePublished - Dec 1 2004

Fingerprint

Waldenstrom Macroglobulinemia
Immunoglobulin M
Therapeutics
Rituximab

Keywords

  • Immunoglobulin
  • Response
  • Rituximab
  • Waldenstrom macroglobulinemia

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Initial immunoglobulin M 'Flare' after rituximab therapy in patients diagnosed with Waldenstrom macroglobulinemia : An Eastern Cooperative Oncology Group Study. / Ghobrial, Irene M.; Fonseca, Rafael; Greipp, Philip R.; Blood, Emily; Rue, Montserrat; Vesole, David H.; Gertz, Morie.

In: Cancer, Vol. 101, No. 11, 01.12.2004, p. 2593-2598.

Research output: Contribution to journalArticle

Ghobrial, Irene M. ; Fonseca, Rafael ; Greipp, Philip R. ; Blood, Emily ; Rue, Montserrat ; Vesole, David H. ; Gertz, Morie. / Initial immunoglobulin M 'Flare' after rituximab therapy in patients diagnosed with Waldenstrom macroglobulinemia : An Eastern Cooperative Oncology Group Study. In: Cancer. 2004 ; Vol. 101, No. 11. pp. 2593-2598.
@article{7bd06fd43ca54b5abedf0337a717cef7,
title = "Initial immunoglobulin M 'Flare' after rituximab therapy in patients diagnosed with Waldenstrom macroglobulinemia: An Eastern Cooperative Oncology Group Study",
abstract = "BACKGROUND. The goal of the current study was to characterize the initial upsurge in immunoglobulin M (IgM) levels after treatment with rituximab in patients with Waldenstrom macroglobulinemia (WM). METHODS. As part of a Phase II Eastern Cooperative Oncology Group study, 72 patients were treated with rituximab (375 mg/m2 weekly for 4 weeks) between April 2000 and January 2002. IgM levels in these patients vvere measured at five separate time points so that any temporal changes that occurred could be characterized. RESULTS. Of the 54 patients for whom the relevant IgM measurements were available, 29 (54{\%}) experienced an increase in IgM levels between baseline and the first scheduled postbaseline time point. At 2 months, 13 of 22 evaluable patients (59{\%}) continued to have elevated IgM levels, and at 4 months, elevated IgM levels persisted in 4 of 15 evaluable patients (27{\%}). Overall, a nonlinear trend characterized by an initial increase in IgM levels followed by a decrease in these levels was observed (P < 0.0001). CONCLUSIONS. Treating physicians should be aware that an IgM 'flare' may occur in up to 54{\%} of patients treated with rituximab; however, most of these patients experience a decrease in IgM levels within 4 months after the initiation of therapy. Therefore, patients should not be discouraged from continuing to receive this potentially effective therapeutic agent, as responses to rituximab may develop slowly. Longer follow-up will reveal whether patients who experience an upsurge in IgM levels have poorer overall survival or shorter times to progression compared with patients who do not experience this IgM flare. Factors predicting an initial increase in IgM levels could not be identified.",
keywords = "Immunoglobulin, Response, Rituximab, Waldenstrom macroglobulinemia",
author = "Ghobrial, {Irene M.} and Rafael Fonseca and Greipp, {Philip R.} and Emily Blood and Montserrat Rue and Vesole, {David H.} and Morie Gertz",
year = "2004",
month = "12",
day = "1",
doi = "10.1002/cncr.20658",
language = "English (US)",
volume = "101",
pages = "2593--2598",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - Initial immunoglobulin M 'Flare' after rituximab therapy in patients diagnosed with Waldenstrom macroglobulinemia

T2 - An Eastern Cooperative Oncology Group Study

AU - Ghobrial, Irene M.

AU - Fonseca, Rafael

AU - Greipp, Philip R.

AU - Blood, Emily

AU - Rue, Montserrat

AU - Vesole, David H.

AU - Gertz, Morie

PY - 2004/12/1

Y1 - 2004/12/1

N2 - BACKGROUND. The goal of the current study was to characterize the initial upsurge in immunoglobulin M (IgM) levels after treatment with rituximab in patients with Waldenstrom macroglobulinemia (WM). METHODS. As part of a Phase II Eastern Cooperative Oncology Group study, 72 patients were treated with rituximab (375 mg/m2 weekly for 4 weeks) between April 2000 and January 2002. IgM levels in these patients vvere measured at five separate time points so that any temporal changes that occurred could be characterized. RESULTS. Of the 54 patients for whom the relevant IgM measurements were available, 29 (54%) experienced an increase in IgM levels between baseline and the first scheduled postbaseline time point. At 2 months, 13 of 22 evaluable patients (59%) continued to have elevated IgM levels, and at 4 months, elevated IgM levels persisted in 4 of 15 evaluable patients (27%). Overall, a nonlinear trend characterized by an initial increase in IgM levels followed by a decrease in these levels was observed (P < 0.0001). CONCLUSIONS. Treating physicians should be aware that an IgM 'flare' may occur in up to 54% of patients treated with rituximab; however, most of these patients experience a decrease in IgM levels within 4 months after the initiation of therapy. Therefore, patients should not be discouraged from continuing to receive this potentially effective therapeutic agent, as responses to rituximab may develop slowly. Longer follow-up will reveal whether patients who experience an upsurge in IgM levels have poorer overall survival or shorter times to progression compared with patients who do not experience this IgM flare. Factors predicting an initial increase in IgM levels could not be identified.

AB - BACKGROUND. The goal of the current study was to characterize the initial upsurge in immunoglobulin M (IgM) levels after treatment with rituximab in patients with Waldenstrom macroglobulinemia (WM). METHODS. As part of a Phase II Eastern Cooperative Oncology Group study, 72 patients were treated with rituximab (375 mg/m2 weekly for 4 weeks) between April 2000 and January 2002. IgM levels in these patients vvere measured at five separate time points so that any temporal changes that occurred could be characterized. RESULTS. Of the 54 patients for whom the relevant IgM measurements were available, 29 (54%) experienced an increase in IgM levels between baseline and the first scheduled postbaseline time point. At 2 months, 13 of 22 evaluable patients (59%) continued to have elevated IgM levels, and at 4 months, elevated IgM levels persisted in 4 of 15 evaluable patients (27%). Overall, a nonlinear trend characterized by an initial increase in IgM levels followed by a decrease in these levels was observed (P < 0.0001). CONCLUSIONS. Treating physicians should be aware that an IgM 'flare' may occur in up to 54% of patients treated with rituximab; however, most of these patients experience a decrease in IgM levels within 4 months after the initiation of therapy. Therefore, patients should not be discouraged from continuing to receive this potentially effective therapeutic agent, as responses to rituximab may develop slowly. Longer follow-up will reveal whether patients who experience an upsurge in IgM levels have poorer overall survival or shorter times to progression compared with patients who do not experience this IgM flare. Factors predicting an initial increase in IgM levels could not be identified.

KW - Immunoglobulin

KW - Response

KW - Rituximab

KW - Waldenstrom macroglobulinemia

UR - http://www.scopus.com/inward/record.url?scp=8844220367&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=8844220367&partnerID=8YFLogxK

U2 - 10.1002/cncr.20658

DO - 10.1002/cncr.20658

M3 - Article

C2 - 15493038

AN - SCOPUS:8844220367

VL - 101

SP - 2593

EP - 2598

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 11

ER -