Abstract
Since the adoption of rituximab as a mainstay of therapy in non-Hodgkin’s lymphoma, there has been growing debate on the importance of adriamycin and vincristine as treatment components used in the therapy of indolent non-Hodgkin’s lymphoma, including Waldenstrom’s macroglobulinemia (WM). We therefore examined the outcome of symptomatic WM patients who required therapy based on consensus guidelines and received treatment at our Institution with CP-R (n=20), CVP-R (n=17), or CHOP-R (n=23). Baseline characteristics for all 3 cohorts were as follows:
Median Age Median Prior Therapies Bone Marrow Involvement sIgM (mg/dL) Hct PLT B2M CP-R 65 (range 42–74) 0 (range 0–2) 45% (range 5–95%) 2620 (range 551–6750) 33.4 270 2.3 CVP-R 60 (range 32–81) 1 (range 0–2) 50% (range 20–90%) 2220 (range 185–8430) 30.0 169 3.3 CHOP-R 54 (range 42–72) 0 (range 0–2) 50% (range 5–90%) 5150 (range 241–12400) 31.0 239 3.6
Responses to therapy, including median decrease in serum IgM and best response for IgM, Hct, and PLT counts were as follows:
ORR(CR+PR+MR) ≥PR CR/nCR % decrease sIgM Post-sIgM Post-Hct Post-PLT p=N.S. for all treatment cohorts. CP-R 90% 80% 0% −54% 1150 38.0 300 CVP-R 88% 71% 12% −67% 790 36.1 219 CHOP-R 83% 70% 17% −63% 794 38.3 230
Adverse events attributed to therapy, including rituximab related IgM flare were as follows:
Neutropenic fever Hospitalizations Treatment related neuropathy IgM flare IgM flare requiring plasmapheresis P=N.S. except as follows: (a) p=0.02; (b) p=0.00006; (c) p=.0.004 versus CPR. CP-R 0% 0% 0% 25% 10% CVP-R 18% 12% 59%b 29% 11% CHOP-R 26%a 17% 35%c 23% 17%
The results of this study demonstrate comparable response characteristics among WM patients treated with CP-R, CVP-R, or CHOP-R though a trend for attainment of more CR/nCR was observed among those patients receiving CVP-R and CHOP-R. Importantly, significantly more toxicity was observed, particularly neutropenic fever and treatment related neuropathy among patients treated with CVP-R and CHOP-R versus CP-R. The results of this study suggest that in WM, the use of CPR may provide analogous treatment responses to more intense cyclophosphamide based regimens, while minimizing treatment related complications.
Waldenstrom’s macroglobulinemia associated with Hodgkin’s lymphoma: a case report