Impact of rituximab and half-dose CHOP as primary therapy for untreated symptomatic Waldenström Macroglobulinemia: review of a combined regimen of rituximab with an alkylating agent.
- Author:
Naohiro SEKIGUCHI
1
;
Airi HAMANO
;
Tomoko KITAGAWA
;
Yuya KURIHARA
;
Kenichi ITO
;
Miwa KURIMOTO
;
Kozo WATANABE
;
Kazuhiko HIRANO
;
Satoshi NOTO
;
Kazuaki YAMADA
;
Naoki TAKEZAKO
Author Information
- Publication Type:Original Article
- Keywords: Waldenström Macroglobulinemia; R-CHOP; Reduced-dose; Primary therapy
- MeSH: Cyclophosphamide; Disasters; Disease-Free Survival; Febrile Neutropenia; Follow-Up Studies; Humans; Leukopenia; Lymphoma, B-Cell; Neutropenia; Peripheral Nervous System Diseases; Prospective Studies; Retrospective Studies; Rituximab*; Survival Rate; Vincristine; Waldenstrom Macroglobulinemia*
- From:Blood Research 2018;53(2):117-122
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Waldenström Macroglobulinemia (WM) is a rare subtype of indolent B-cell lymphoma, and prospective randomized studies on WM are scarce. The R-CHOP therapy [rituximab (R), cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone] is a popular and recommended regimen for primary therapy, prescribed by several treatment guidelines for WM. However, treatment with R-CHOP is accompanied by severe myelosuppression and high rates of peripheral neuropathy. Therefore, we retrospectively evaluated the efficacy and toxicity of half-dose CHOP combined with R as a primary therapy for WM. METHODS: Patients with untreated symptomatic WM, treated at the Disaster Medical Center between April 2011 and September 2016, were retrospectively analyzed after administration of 6 cycles of half-dose R-CHOP for every 3 weeks. The response, median time to response, best response, progression-free survival, overall survival, and toxicities were evaluated. RESULTS: Of the 20 WM patients analyzed, 16 (80%) received half-dose R-CHOP without vincristine, and 13 (65%) responded to the treatment. With a median follow-up duration of 26.3 months, the 2-year progression-free survival and 2-year overall survival rates were 70 and 93.3%, respectively. The median time to response and best response were 6 and 9.9 weeks, respectively. Grade 3/4 leukocytopenia, neutropenia, febrile neutropenia, and Grade 1 peripheral neuropathy developed in 32, 37, 0, and 21% of patients, respectively. CONCLUSION: The half-dose R-CHOP is an effective and well-tolerated primary therapy for WM. To the best of our knowledge, this is the first study reporting the use of a reduced-dose R-CHOP regimen for the primary treatment of WM.
