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KMID : 1142020180530020117
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Blood Research
2018 Volume.53 No. 2 p.117 ~ p.122
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Impact of rituximab and half-dose CHOP as primary therapy for untreated symptomatic Waldenstrom Macroglobulinemia: review of a combined regimen of rituximab with an alkylating agent
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Sekiguchi Naohiro
Hamano Airi
Kitagawa Tomoko
Kurihara Yuya
Ito Kenichi
Kurimoto Miwa
Watanabe Kozo
Hirano Kazuhiko
Noto Satoshi
Yamada Kazuaki
Takezako Naoki
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Abstract
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Background: Waldenstrom Macroglobulinemia (WM) is a rare subtype of indolent B-cell lymphoma, and prospective randomized studies on WM are scarce. The R-CHOP therapy [rituximab (R), cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone] is a popular and recommended regimen for primary therapy, prescribed by several treatment guidelines for WM. However, treatment with R-CHOP is accompanied by severe myelosuppression and high rates of peripheral neuropathy. Therefore, we retrospectively evaluated the efficacy and toxicity of half-dose CHOP combined with R as a primary therapy for WM.
Methods: Patients with untreated symptomatic WM, treated at the Disaster Medical Center between April 2011 and September 2016, were retrospectively analyzed after administration of 6 cycles of half-dose R-CHOP for every 3 weeks. The response, median time to response, best response, progression-free survival, overall survival, and toxicities were evaluated.
Results: Of the 20 WM patients analyzed, 16 (80%) received half-dose R-CHOP without vincristine, and 13 (65%) responded to the treatment. With a median follow-up duration of 26.3 months, the 2-year progression-free survival and 2-year overall survival rates were 70 and 93.3%, respectively. The median time to response and best response were 6 and 9.9 weeks, respectively. Grade 3/4 leukocytopenia, neutropenia, febrile neutropenia, and Grade 1 peripheral neuropathy developed in 32, 37, 0, and 21% of patients, respectively.
Conclusion: The half-dose R-CHOP is an effective and well-tolerated primary therapy for WM. To the best of our knowledge, this is the first study reporting the use of a reduced-dose R-CHOP regimen for the primary treatment of WM.
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KEYWORD
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Waldenstrom Macroglobulinemia, R-CHOP, Reduced-dose, Primary therapy
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