Sequential Treatment Escalation May Extend Survival for Patients With Waldenström Macroglobulinemia

According to a recent study, sequential treatment escalation may improve the survival of patients with Waldenström macroglobulinemia (WM), a type of indolent B-cell lymphoma that is prone to relapse. 

Study investigators analyzed the outcomes of the first- and second-line therapies in 377 patients with WM to determine optimal choices for second-line therapy. Succeeding a median follow-up period of 45.4 months, 89 patients received second-line therapy, and 53 patients were evaluated for response. 

Results demonstrated that the major response rates (MRR) of first and second-line treatments were 65.1% and 67.9% (P = 0.678), respectively. The median progression-free survival (PFS) for the second-line therapy (PFS2) was noted to be shorter than that for the first-line therapy (PFS1) (56.3 vs 40.7 months, P = 0.03). However, PFS2 in the targeted drugs group (rituximab-/bortezomib-/Bruton tyrosine kinase inhibitor [BTK]-based regimens) was comparable to PFS1 (60.7 months vs 44.7 months, respectively, P = 0.21). 

As for evaluation of second-line therapy, patients who underwent sequential treatment escalation, such as transitioning from cytotoxic drugs to rituximab-/bortezomib-/BTK-inhibitor-based regimens, or from rituximab-/bortezomib-based to BTK-inhibitor-based regimens, known as the escalation group, had higher MRR (80.6% vs 47.1%, respectively, P = 0.023) and longer PFS2 (50.4 vs 23.5 months, respectively, P < 0.001) compared to the non-escalation group. Additionally, participants in the escalation group had longer post-relapse overall survival compared with the non-escalation group (median, 50.4 vs 23.5 months, respectively, P = 0.039).

Ying Yu, MD, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China, and colleagues concluded, “Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.” 

Source:

Yu Y, Xiong W, Wang T, et al. Sequential treatment escalation improves survival in patients with waldenstrom macroglobulinemia. Blood Sci. Published online January 17, 2024. doi: 10.1097/BS9.0000000000000179