Abstract
Waldenström macroglobulinemia (WM) is a distinct indolent B-cell lymphoproliferative malignancy characterized by IgM paraproteinemia. Although the disease is sensitive to chemo-immunotherapy, it remains incurable and affected patients have a median survival of 5–10 years. Risk stratification in newly diagnosed patients should start with a prognostic evaluation based on the International Prognostic Scoring System for WM (IPSSWM) to identify those patients in whom particularly poor survival with chemotherapy is expected and in whom alternative treatment strategies, such as hematopoietic cell transplantation (HCT), should be considered. High-dose chemotherapy followed by autologous HCT (auto-HCT) results in disease-free survival of 45–65% at 5 years, but is unlikely to be curative. Chemosensitive disease at the time of auto-HCT is the most important prognostic factor for response rate and overall survival. Allogeneic donor HCT may offer a unique immune-mediated GVL effect with a plateau in relapse rates and potential for extended disease-free survival. The risk of allogeneic HCT complications is justified in HCT-eligible patients whose expected survival is <5 years. Here, we present the advances in non-transplant strategies and the therapeutic role of transplant, and suggest a treatment algorithm for selecting a HCT strategy while adhering to current evidence supporting autologous and allogeneic donor HCT for WM.
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References
Dimopoulos MA, Kyle RA, Anagnostopoulos A, Treon SP . Diagnosis and management of Waldenstrom's macroglobulinemia. J Clin Oncol 2005; 23: 1564–1577.
Swerdlow S, Campo E, Nea H (eds). WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th edn. International Agency for Research on Cancer: Lyon, France, 2008, p 194. ISBN 978-92-832-2431-0.
Owen RG, Treon SP, Al-Katib A, Fonseca R, Greipp PR, McMaster ML et al. Clinico-pathological definition of Waldenstrom's macroglobulinemia: consensus panel recommendations from the second international workshop on Waldenstrom's macroglobulinemia. Semic Oncol 2003; 30: 110–115.
Dimopoulos MA, Gertz MA, Kastritis E, Garcia-Sanz R, Kimby EK, Leblond V et al. Update on treatment recommendations from the fourth international workshop on Waldenstrom's macroglobulinemia. J Clin Oncol 2009; 27: 120–126.
Treon SP . How I treat Waldenstrom macroglobulinemia. Blood 2009; 114: 2375–2385.
Morel P, Duhamel A, Gobbi P, Dimopoulos MA, Dhodapkar MV, McCoy J et al. International prognostic scoring system for Waldenstrom macroglobulinemia. Blood 2009; 113: 4163–4170.
Kastritis E, Kyrtsonis MC, Hadjiharissi E, Symeonidis A, Michalis E, Repoussis P et al. Validation of the International Prognostic Scoring System (IPSS) for Waldenstrom's macroglobulinemia (WM) and the importance of serum lactate dehydrogenase (LDH). Leuk Res 2010; 34: 1340–1343.
Ghobrial IM, Gertz M, Laplant B, Camoriano J, Hayman S, Lacy M et al. Phase II trial of the oral mammalian target of rapamycin inhibitor everolimus in relapsed or refractory Waldenstrom macroglobulinemia. J Clin Oncol 2010; 28: 1408–1414.
Ghobrial IM, Hong F, Padmanabhan S, Badros A, Rourke M, Leduc R et al. Phase II trial of weekly bortezomib in combination with rituximab in relapsed or relapsed and refractory Waldenstrom macroglobulinemia. J Clin Oncol 2010; 28: 1422–1428.
Rourke M, Anderson KC, Ghobrial IM . Review of clinical trials conducted in Waldenstrom macroglobulinemia and recommendations for reporting clinical trial responses in these patients. Leuk Lymphoma 2010; 51: 1779–1792.
Vijay A, Gertz MA . Waldenstrom macroglobulinemia. Blood 2007; 109: 5096–5103.
Anagnostopoulos A, Aleman A, Giralt S . Autologous and allogeneic stem cell transplantation in Waldenstrom's macroglobulinemia: review of the literature and future directions. Semin Oncol 2003; 30: 286–290.
Dreger P, Glass B, Kuse R, Sonnen R, von Neuhoff N, Bolouri H et al. Myeloablative radiochemotherapy followed by reinfusion of purged autologous stem cells for Waldenstrom's macroglobulinaemia. Br J Haematol 1999; 106: 115–118.
Munshi NC, Barlogie B . Role for high-dose therapy with autologous hematopoietic stem cell support in Waldenstrom's macroglobulinemia. Semin Oncol 2003; 30: 282–285.
Tournilhac O, Leblond V, Tabrizi R, Gressin R, Senecal D, Milpied N et al. Transplantation in Waldenstrom's macroglobulinemia--the French experience. Semin Oncol 2003; 30: 291–296.
Anagnostopoulos A, Hari PN, Perez WS, Ballen K, Bashey A, Bredeson CN et al. Autologous or allogeneic stem cell transplantation in patients with Waldenstrom's macroglobulinemia. Biol Blood Marrow Transplant 2006; 12: 845–854.
Gilleece MH, Pearce R, Linch DC, Wilson M, Towlson K, Mackinnon S et al. The outcome of haemopoietic stem cell transplantation in the treatment of lymphoplasmacytic lymphoma in the UK: a British Society Bone Marrow Transplantation study. Hematology 2008; 13: 119–127.
Kyriakou C, Canals C, Sibon D, Cahn JY, Kazmi M, Arcese W et al. High-dose therapy and autologous stem-cell transplantation in Waldenstrom macroglobulinemia: the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2010; 28: 2227–2232.
Dreger P, Schmitz N . Autologous stem cell transplantation as part of first-line treatment of Waldenstrom's macroglobulinemia. Biol Blood Marrow Transplant 2007; 13: 623–624.
Caravita T, Siniscalchi A, Tendas A, Cupelli L, Dentamaro T, Natale G et al. High-dose therapy with autologous PBSC transplantation in the front-line treatment of Waldenstrom's macroglobulinemia. Bone Marrow Transplant 2009; 43: 587–588.
Stakiw J, Kim DH, Kuruvilla J, Gupta V, Messner H, Lipton JH . Evidence of graft-versus-Waldenstrom's macroglobulinemia effect after allogeneic stem cell transplantation: a single centre experience. Bone Marrow Transplant 2007; 40: 369–372.
Maloney DG . Evidence for GWM following mini-allo in WM. Presented at the Fifth International Workshop for Waldentrom's Macroglobulinemia; Stockholm, 2008 (abstract 147).
Garnier A, Robin M, Larosa F, Golmard JL, Le Gouill S, Coiteux V et al. Allogeneic hematopoietic stem cell transplantation allows long-term complete remission and curability in high-risk Waldenstrom's macroglobulinemia. Results of a retrospective analysis of the Societe Francaise de Greffe de Moelle et de Therapie Cellulaire. Haematologica 2010; 95: 950–955.
Kyriakou C, Canals C, Cornelissen JJ, Socie G, Willemze R, Ifrah N et al. Allogeneic stem-cell transplantation in patients with Waldenstrom macroglobulinemia: report from the lymphoma working party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2010; 28: 4926–4934.
Ansell SM, Kyle RA, Reeder CB, Fonseca R, Mikhael JR, Morice WG et al. Diagnosis and management of Waldenstrom macroglobulinemia: Mayo stratification of macroglobulinemia and risk-adapted therapy (mSMART) guidelines. Mayo Clin Proc 2010; 85: 824–833.
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We appreciate the editorial assistance of Michael Franklin and Carol Taubert.
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Bachanova, V., Burns, L. Hematopoietic cell transplantation for Waldenström macroglobulinemia. Bone Marrow Transplant 47, 330–336 (2012). https://doi.org/10.1038/bmt.2011.105
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DOI: https://doi.org/10.1038/bmt.2011.105
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