1
|
Grunenberg A, Buske C. How to manage waldenström's macroglobulinemia in 2024. Cancer Treat Rev 2024; 125:102715. [PMID: 38471356 DOI: 10.1016/j.ctrv.2024.102715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
Clinical management of Waldenström's Macroglobulinemia has seen major progress in the recent years, triggered by our improved understanding of the biology of the disease and the development of new therapies. Based on this there are multiple treatment options available for patients with WM ranging from classical immunochemotherapy to targeted approaches blocking key enzymes involved in lymphoma growth. This review summarizes our current knowledge about diagnostics and treatment of this rare but recurrent lymphoma subtype, which often presents a major clinical challenge in daily clinical life.
Collapse
Affiliation(s)
| | - Christian Buske
- Department of Internal Medicine III, University Hospital Ulm, Germany; Institute of Experimental Cancer Research, University Hospital, Germany.
| |
Collapse
|
2
|
Cencini E, Romano I, Ghio F, Camerini C, Bertaggia I, Giachetti R, Mannelli L, Pirrotta MT, Navei GL, Ciceri M, Cervetti G, Sant'Antonio E, Simonetti F, Birtolo S, Puccini B, Bocchia M, Fabbri A. Ibrutinib in relapsed/refractory patients with Waldenström macroglobulinemia: a real-life, retrospective study on behalf of the "RTL" (regional Tuscan lymphoma network). Ann Hematol 2023; 102:841-849. [PMID: 36735074 DOI: 10.1007/s00277-023-05113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
Ibrutinib represents the first approved treatment for patients with Waldenström macroglobulinemia (WM). There are very few published experiences outside of a clinical trial. In this study, we investigated treatment response, survival, and safety in a real life setting. We retrospectively analyzed 49 consecutive R/R WM patients, managed in 8 Tuscan onco-hematological centers, that received ibrutinib after its approval, at a maximum dose of 420 mg once per day, until disease progression or unacceptable toxicity. Median age was 65 years (range 32-86), and the median number of previous regimens was 2 (range 1-5). Overall and major response rate were 91.8% and 87.7%, respectively. At best response, median IgM level declined from 3,094 to 831 mg/dl, and Hb level increased from 10.4 to 12.7 g/dl. In an intention-to-treat analysis, 36/49 patients (73.5%) were still receiving treatment, while 13/49 (26.5%) had discontinued therapy. Six out of 49 cases (12.2%) relapsed after an initial response, and 13/49 (26.5%) had a dose reduction. Estimated 2-year PFS, DOR, and OS were 76.7%, 88.7%, and 84.1%, respectively. After a median follow-up of 18.3 months, 43/49 patients (87.8%) were alive. The most frequent AE included atrial fibrillation or flutter (6/49 cases, 12.2%), bleeding (6/49 cases, 12.2%), arthralgia/myalgia (5/49 cases, 10.2%). Ibrutinib is a suitable treatment option for R/R WM patients and also suggested by ESMO, NCCN, and other societies. PFS and OS were durable, and DOR was sustained for responsive patients. Treatment toxicity is not negligible, but manageable in most cases without treatment discontinuation.
Collapse
Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
| | - Ilaria Romano
- Hematology Department, Careggi Hospital and University of Florence, Florence, Italy
| | - Francesco Ghio
- Unit of Hematology, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy
| | - Chiara Camerini
- UOC Ematologia Aziendale, Azienda USL Toscana Nordovest, Ospedale S. Luca, Lucca, Italy
| | - Ilaria Bertaggia
- UOC Ematologia Aziendale, Ospedale Versilia, Lido di Camaiore, Italy
| | | | - Lara Mannelli
- SOS Oncoematologia, Ospedale S. Stefano, Prato, Italy
| | | | - Giulia Lucco Navei
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Manuel Ciceri
- Hematology Department, Careggi Hospital and University of Florence, Florence, Italy
| | - Giulia Cervetti
- Unit of Hematology, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy
| | - Emanuela Sant'Antonio
- UOC Ematologia Aziendale, Azienda USL Toscana Nordovest, Ospedale S. Luca, Lucca, Italy
| | | | | | - Benedetta Puccini
- Hematology Department, Careggi Hospital and University of Florence, Florence, Italy
| | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| |
Collapse
|
3
|
Bohn JP, Dietrich S. Treatment of Classic Hairy Cell Leukemia: Targeting Minimal Residual Disease beyond Cladribine. Cancers (Basel) 2022; 14:cancers14040956. [PMID: 35205704 PMCID: PMC8869886 DOI: 10.3390/cancers14040956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Standard treatment with purine analogues facilitates a near normal life expectancy in the majority of patients with classic hairy cell leukemia (HCL), a rare chronic B-cell malignancy. However, nearly all patients ultimately relapse and require retreatment, while drug-induced myelotoxicity accumulates predisposing to infectious complications and, possibly, secondary malignancies. Persistence of minimal residual disease (MRD) in a substantial portion of treated patients has become a surrogate for this still limited treatment efficacy. New insights into disease biology initiated design and investigation of several new, chemotherapy-free, targeted drugs with encouraging efficacy in early clinical trials aimed at enhancing eradication of MRD and optimizing drug tolerability. This review provides an update on recent clinical trials investigating treatment strategies beyond purine analogues in HCL and discusses clinically relevant obstacles still to overcome. Abstract Classic hairy cell leukemia (HCL) is a rare indolent B-cell lymphoproliferative disorder characterized by profound pancytopenia and frequent infectious complications due to progressive infiltration of the bone marrow and spleen. Lacking effective treatment options, affected patients were confronted with a dismal survival prognosis of less than 5 years when the disease was first described in 1958. Tremendous therapeutic advances were accomplished with the introduction of purine analogues such as cladribine in the 1990s, facilitating a near-normal life expectancy in most HCL patients. Nevertheless, nearly all patients eventually relapse and require successive retreatments, while drug-associated myelotoxicity may accumulate and secondary malignancies may evolve. Detection of minimal residual disease (MRD) in a substantial portion of treated patients has become a surrogate for this still limited treatment efficacy. In the last decade, novel biologic insights such as identification of the driver mutation BRAF V600E have initiated the development and clinical investigation of new, chemotherapy-free, targeted drugs in HCL treatment, with encouraging efficacy in early clinical trials aimed at boosting eradication of MRD while optimizing drug tolerability. This review summarizes current clinical trials investigating treatment strategies beyond purine analogues in HCL and discusses clinically relevant obstacles still to overcome.
Collapse
Affiliation(s)
- Jan-Paul Bohn
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, A-6020 Innsbruck, Austria
- Correspondence:
| | - Sascha Dietrich
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany;
| |
Collapse
|
4
|
Staber PB, Kersten MJ. EHA Endorsement of ESMO Clinical Practice Guidelines for Diagnosis, Treatment, and Follow-up for Waldenström's Macroglobulinemia. Hemasphere 2021; 5:e634. [PMID: 34522842 DOI: 10.1097/HS9.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022] Open
|
5
|
Grunenberg A, Buske C. Rituximab and ibrutinib in the treatment of Waldenström's macroglobulinemia. Future Oncol 2019; 15:2687-2697. [PMID: 31184501 DOI: 10.2217/fon-2019-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Bruton's tyrosine kinase inhibitor ibrutinib represents a highly effective single substance in the treatment of Waldenström's macroglobulinemia. Ibrutinib monotherapy is a valid therapeutic option either in the relapsed or refractory setting or in patients first line, particulary when they are ineligible for chemotherapy. However, the treatment success depends on the genotype. Recent data suggest that ibrutinib in combination with rituximab may partially overcome this genotype dependency.
Collapse
Affiliation(s)
| | - Christian Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
| |
Collapse
|