Dexamethasone, Rituximab, and Cyclophosphamide Effective in Waldenström Macroglobulinemia

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In patients with R/R WM, the overall response rate was 87%, with 4% of patients achieving a very good partial response.
In patients with R/R WM, the overall response rate was 87%, with 4% of patients achieving a very good partial response.

Dexamethasone, rituximab, and cyclophosphamide (DRC) is a safe and effective option for patients with treatment-naive or relapsed/refractory (R/R) Waldenström macroglobulinemia (WM), according to a study published in the British Journal of Haematology.1

DRC is effective as a first-line therapy for patients with treatment-naive WM, but its efficacy in patients with R/R WM is unknown.

For this study, researchers administered intravenous (IV) dexamethasone 20 mg and rituximab 375 mg/m2 on day 1 and cyclophosphamide 100 mg/m2 on days 1 to 5 every 3 weeks for up to 6 cycles to 100 patients. Fifty patients progressed to R/R WM. Only patients who completed at least 1 cycle were included in the final analysis.

In patients with R/R WM, the overall response rate (ORR) was 87%, with 4% of patients achieving a very good partial response (VGPR), 64% achieving a partial response (PR), and 19% achieving a minimal response (MR). Nine percent of patients achieved stable disease, and 4% of patients progressed after therapy.

The median follow-up in patients who received DRC in the R/R setting was 51 months. The median progression-free survival (PFS) was 32 months (95% CI, 15-51), and time-to-next-therapy (TTNT) was 50 months (95% CI, 35-60).

For treatment-naive patients who received DRC as frontline therapy, the ORR was 96%, with 17%, 70%, and 9% of patients achieving VGPR, PR, and MR, respectively. Stable disease was achieved in 4% of patients.

The median follow-up was 30 months for front-line DRC patients. The median PFS was 34 months (95% CI, 23-not reached [NR]). The median TTNT was NR (95% CI, 37-NR).

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The most frequently reported grade 3 or worse adverse events (AEs) were neutropenia, thrombocytopenia, and infection.

Reference

  1. Paludo J, Abeykoon JP, Kumar S, et al. Dexamethasone, rituximab and cyclophosphamide for relapsed and/or refractory and treatment-naïve patients with Waldenström macroglobulinaemia. Br J Haematol. 2017 Aug 8. doi: 10.1111/bjh.14826 [Epub ahead of print]

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