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 |
| . | 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 |
| . | 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% |
| . | 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.
Disclosures: No relevant conflicts of interest to declare.
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