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Treatment of Waldenstrom's macroglobulinemia with rituximab: prognostic factors for response and progression



Treatment of Waldenstrom's macroglobulinemia with rituximab: prognostic factors for response and progression



Leukemia & Lymphoma 45(10): 2057-2061



Introduction: Recent data suggest that rituximab is an active agent for the treatment of Waldenstrom's macroglobulinemia. However the patients that are more likely to benefit have not been clearly defined. In order to address this question we evaluated a large number of patients who were treated with single agent rituximab. Patients and Methods: All patients treated with single agent rituximab in the context of prospective studies conducted by the Greek Myeloma Study Group or at the MD Anderson Cancer Center were identified. Several clinical and laboratory variables were assessed for their correlation with response and time to progression. These included: age, gender, type of light chain, hyperviscosity, splenomegaly, lymphadenopathy, hemoglobin, platelet count, serum monoclonal protein, albumin, b2 microglobulin and disease status. Results: Fifty-two patients with WM were included in the analysis with the following characteristics: age gtoreq65 years: 64%, hemoglobin <10g/dl: 42%, platelets <100X109: 12%, serum albumin <3.5 g/dl: 25%, serum monoclonal protein (m-protein) gtoreq4.0g/dl: 33%, serum b2 microglobulin >3.5 mg/dl: 39%, previously untreated: 44%. Twenty-three patients (44%) achieved at least 50% reduction of monoclonal protein and of tumor infiltrate at all involved sites. Previously untreated and pretreated patients had the same probability for response. Higher response rates were associated with m-protein <4.0g/dl, and with albumin gtoreq3.5 g/dl. The median time to progression for all patients was 13.8 months. With a median follow-up of 30 months the median time to progression for responding patients has not been reached and for patients rated as stable disease it was 12 months. Variables associated with longer time to progression on were m-protein <4.0 g/dl, hemoglobin gtoreq10 g/dl, albumin gtoreq3.5g/dl and absence of lymphadenopathy. A Cox regression analysis indicated that serum monoclonal protein and albumin were the dominant predictive factoers for time to progression. Conclusions: We conclude that rituximab is an effective treatment modality for patients with WM. Our analysis identified several readily available parameters that were associated with higher response rate and longer time to progression. Such variables may help to identify patients with WM who are likely to benefit from treatment with rituximab.

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Accession: 035980648

Download citation: RISBibTeXText

PMID: 15370250

DOI: 10.1080/10428190410001723287



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