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DGI-074 Treatment and Prognosis in Patients with Waldenstrom’s Macorglobulinemia
  1. A Izquierdo,
  2. S Martínez,
  3. A Alfaro,
  4. M Merchante,
  5. L Sanchez-Rubio,
  6. A Zorzano,
  7. MF Hurtado
  1. San Pedro Hospital, Hospital Pharmacy, Logroño, Spain

Abstract

Background Waldenstrom’s macroglobulinemia (MW) is an uncommon lymphoproliferative disorder of the B cells, associated with overproduction of the monoclonal component Immunoglobulin M (IgM).

Purpose To analyse the treatment and outcome of patients with MW.

Materials and Methods Observational, retrospective and descriptive study of all patients diagnosed with MW from 2001 to the present day. A cytostatic dispensing programme (OncoGest) and the electronic history (Selene) were used to gather the following data: gender, age, year of diagnosis, previous treatments, treatment regime, adverse reactions. The treatment response was rated according to symptom let-up and decrease in the serum IgM.

Results 8 MW patients were included, their average age was 72 years old (rank: 51–82), of which 50% were male.

The symptoms with which patients presented before commencing treatment included: asthenia (100%), anorexia, peripheral neuropathy (37.5%), anaemia (25%), hyperviscosity syndrome (62.5%); 40% of patients required a session of plasmapheresis.

Various treatment regimens were used: Two of the patients commenced treatment with fludarabine, one started with cladribine and two with chlorambucil. Patients with fludarabine had a good response and in the other three cases the response was quite low; as a result, treatment was changed to weekly rituximab until the symptoms stopped and the IgM decreased. Three of the patients started treatment with weekly rituximab with a good response in two of the cases and one had a low response so the treatment was changed to rituximab with cladribine.

All patients except one who is currently receiving rituximab and cladribine have had relapses after the first treatment. They were treated with weekly rituximab until the symptoms stopped, except in two of the cases, who currently continue with maintenance rituximab every two and three months respectively.

As regards tolerance and adverse reactions, neutropenia appeared in just one patient treated with chlorambucil, the treatments were well tolerated by the remaining patients.

Conclusions Various drugs are used for the treatment of MW: chlorambucil, fludarabine, cladribine and rituximab, alone or in combination. The treatment regimen the most commonly used, especially if weekly rituximab, especially for those patients that have had relapses with other treatments. Weekly rituximab is a treatment with a good response rate and is well tolerated.

No conflict of interest.

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