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Sydney 2005:
Treatment of Waldenstrom's Macroglobulinemia
By Meletios Dimopoulos, MD
Dr. Dimopoulous offered an overview of the current and emerging treatment options for WM. Dr. Dimopoulos detailed the clinical considerations for initiating treatment for the patient with WM as Hb ¡Ü10 g/dL; platelet counts <100 x 109 /L, bulky adenopathy, and significant organomegaly. For symptomatic patients requiring treatment, there are 3 front-line options available: alkylating agents, nucleoside analogues, and monoclonal antibody rituximab. With alkylating agent, chlorambucil,50% to 70% of patients achieve responses. With nucleoside analogues, fludarabine and cladribine, responses occur in 40% to 80% of previously untreated patients. Fludaribine and cladribine have also shown to be effective as salvage treatment. Limited data are available on high dose therapy (HDT); however, preliminary results show a high response rate even in resistant patients (100% CR). Studies with rituximab show that time to response is slow¨Can average of 4 months. Because rituximab is not myelosuppressive or toxic to stem cells rituximab may be the ideal option for patients who are candidates for stem cell collection, although not a good option for patients requiring rapid disease control. More recently there has been considerable interest in combination therapies with novel agents. With these new options on the horizon, Dr. Dimopoulous encouraged the consideration of patient factors such as age, comorbid conditions, the need for rapid disease control, and candidacy for high-dose therapy to identify the most appropriate treatment for the patient with WM.

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