Difference between revisions of "Waldenström macroglobulinemia"
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
+ | |||
+ | =Untreated (first-line)= | ||
+ | |||
+ | ==BDR== | ||
+ | BDR: '''<u>B</u>'''ortezomib, '''<u>D</u>'''examethasone, '''<u>R</u>'''ituximab | ||
+ | |||
+ | ===Regimen=== | ||
+ | *[[Bortezomib (Velcade)]] 1.3 mg/m2 IV on days 1, 4, 8, 11 | ||
+ | *[[Dexamethasone (Decadron)]] 40 mg IV on days 1, 4, 8, 11 | ||
+ | *[[Rituximab (Rituxan)]] 375 mg/m2 IV on day 11 | ||
+ | |||
+ | Supportive medications: | ||
+ | *[[Valacyclovir (Valtrex)]] 1 gm PO once per day or [[Acyclovir (Zovirax)]] 400 mg PO twice per day was recommended for shingles prophylaxis | ||
+ | *"The prophylactic use of plasmapheresis was recommended for patients demonstrating an IgM level of ≥ 5,000 mg/dL before the administration of rituximab, given the potential for rituximab-mediated IgM flare and aggravation of hyperviscosity." | ||
+ | |||
+ | ===References=== | ||
+ | # Treon SP, Ioakimidis L, Soumerai JD, Patterson CJ, Sheehy P, Nelson M, Willen M, Matous J, Mattern J 2nd, Diener JG, Keogh GP, Myers TJ, Boral A, Birner A, Esseltine DL, Ghobrial IM. Primary therapy of Waldenström macroglobulinemia with bortezomib, dexamethasone, and rituximab: WMCTG clinical trial 05-180. J Clin Oncol. 2009 Aug 10;27(23):3830-5. doi: 10.1200/JCO.2008.20.4677. Epub 2009 Jun 8. [http://jco.ascopubs.org/content/27/23/3830.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19506160 PubMed] | ||
+ | |||
+ | ==Bortezomib and Rituximab== | ||
+ | |||
+ | ===Regimen=== | ||
+ | *[[Bortezomib (Velcade)]] 1.6 mg/m2 IV days 1, 8, 15 | ||
+ | *[[Rituximab (Rituxan)]] 375 mg/m2 IV on days 1, 8, 15, 22 (cycles 1 and 4, only) | ||
+ | |||
+ | Supportive medications: | ||
+ | "Antiviral prophylaxis was recommended in all patients prior to initiation of therapy and for 3 months after completion of the six cycles." | ||
+ | |||
+ | '''28-day cycles x up to 6 cycles''' | ||
+ | |||
+ | ===References=== | ||
+ | # Ghobrial IM, Xie W, Padmanabhan S, Badros A, Rourke M, Leduc R, Chuma S, Kunsman J, Warren D, Poon T, Harris B, Sam A, Anderson KC, Richardson PG, Treon SP, Weller E, Matous J. Phase II trial of weekly bortezomib in combination with rituximab in untreated patients with Waldenström Macroglobulinemia. Am J Hematol. 2010 Sep;85(9):670-4. doi: 10.1002/ajh.21788. [http://onlinelibrary.wiley.com/doi/10.1002/ajh.21788/full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20652865 PubMed] | ||
=Relapsed/Refractory= | =Relapsed/Refractory= |
Revision as of 15:38, 24 May 2013
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Untreated (first-line)
BDR
BDR: Bortezomib, Dexamethasone, Rituximab
Regimen
- Bortezomib (Velcade) 1.3 mg/m2 IV on days 1, 4, 8, 11
- Dexamethasone (Decadron) 40 mg IV on days 1, 4, 8, 11
- Rituximab (Rituxan) 375 mg/m2 IV on day 11
Supportive medications:
- Valacyclovir (Valtrex) 1 gm PO once per day or Acyclovir (Zovirax) 400 mg PO twice per day was recommended for shingles prophylaxis
- "The prophylactic use of plasmapheresis was recommended for patients demonstrating an IgM level of ≥ 5,000 mg/dL before the administration of rituximab, given the potential for rituximab-mediated IgM flare and aggravation of hyperviscosity."
References
- Treon SP, Ioakimidis L, Soumerai JD, Patterson CJ, Sheehy P, Nelson M, Willen M, Matous J, Mattern J 2nd, Diener JG, Keogh GP, Myers TJ, Boral A, Birner A, Esseltine DL, Ghobrial IM. Primary therapy of Waldenström macroglobulinemia with bortezomib, dexamethasone, and rituximab: WMCTG clinical trial 05-180. J Clin Oncol. 2009 Aug 10;27(23):3830-5. doi: 10.1200/JCO.2008.20.4677. Epub 2009 Jun 8. link to original article contains verified protocol PubMed
Bortezomib and Rituximab
Regimen
- Bortezomib (Velcade) 1.6 mg/m2 IV days 1, 8, 15
- Rituximab (Rituxan) 375 mg/m2 IV on days 1, 8, 15, 22 (cycles 1 and 4, only)
Supportive medications: "Antiviral prophylaxis was recommended in all patients prior to initiation of therapy and for 3 months after completion of the six cycles."
28-day cycles x up to 6 cycles
References
- Ghobrial IM, Xie W, Padmanabhan S, Badros A, Rourke M, Leduc R, Chuma S, Kunsman J, Warren D, Poon T, Harris B, Sam A, Anderson KC, Richardson PG, Treon SP, Weller E, Matous J. Phase II trial of weekly bortezomib in combination with rituximab in untreated patients with Waldenström Macroglobulinemia. Am J Hematol. 2010 Sep;85(9):670-4. doi: 10.1002/ajh.21788. link to original article contains verified protocol PubMed
Relapsed/Refractory
Bortezomib and Rituximab
Regimen
- Bortezomib (Velcade) 1.6 mg/m2 IV days 1, 8, 15
- Rituximab (Rituxan) 375 mg/m2 IV on days 1, 8, 15, 22 (cycles 1 and 4, only)
28-day cycles x up to 6 cycles
References
- Ghobrial IM, Hong F, Padmanabhan S, Badros A, Rourke M, Leduc R, Chuma S, Kunsman J, Warren D, Harris B, Sam A, Anderson KC, Richardson PG, Treon SP, Weller E, Matous J. Phase II trial of weekly bortezomib in combination with rituximab in relapsed or relapsed and refractory Waldenstrom macroglobulinemia. J Clin Oncol. 2010 Mar 10;28(8):1422-8. doi: 10.1200/JCO.2009.25.3237. Epub 2010 Feb 8. link to original article contains verified protocol PubMed
Everolimus
Regimen
- Everolimus (Afinitor) 10 mg PO once per day
28-day cycles, given until progression or unacceptable toxicity
References
- Ghobrial IM, Gertz M, Laplant B, Camoriano J, Hayman S, Lacy M, Chuma S, Harris B, Leduc R, Rourke M, Ansell SM, Deangelo D, Dispenzieri A, Bergsagel L, Reeder C, Anderson KC, Richardson PG, Treon SP, Witzig TE. Phase II trial of the oral mammalian target of rapamycin inhibitor everolimus in relapsed or refractory Waldenstrom macroglobulinemia. J Clin Oncol. 2010 Mar 10;28(8):1408-14. doi:10.1200/JCO.2009.24.0994. Epub 2010 Feb 8. link to original article contains verified protocol PubMed
Panobinostat
Regimen
- Panobinostat (LBH589) 30 mg PO 3 days per week (Mondays, Wednesdays, and Fridays)
28-day cycles, given until progression of disease
References
- Ghobrial IM, Campigotto F, Murphy TJ, Boswell EN, Banwait R, Azab F, Chuma S, Kunsman J, Donovan A, Masood F, Warren D, Rodig S, Anderson KC, Richardson PG, Weller E, Matous J. Results of a phase 2 trial of the single-agent histone deacetylase inhibitor panobinostat in patients with relapsed/refractory Waldenstrom macroglobulinemia. Blood. 2013 Feb 21;121(8):1296-303. doi:10.1182/blood-2012-06-439307. Epub 2013 Jan 3. link to original article contains verified protocol PubMed