Guide to therapy of previously treated WM. ASCT, autologous stem cell transplant; RIC, reduced intensity allogeneic stem cell transplant; IB, ibrutinib; NA, nucleoside analog-based therapy. 1Can be considered in patients not previously treated with IB, who are not wild type for MYD88, and for those patients without bulky adenopathy or Bing-Neel syndrome. 2In patients being considered for an ASCT, stem cell collection should be undertaken before exposure to a nucleoside analog. Rituximab should be held in patients with symptomatic HV, severe CRYO or CAGG, and in asymptomatic patients with serum IgM >4000 mg/dL to avoid an IgM flare and potentiation of symptoms. Ofatumumab may be considered for rituximab-intolerant patients. Consider maintenance rituximab for patients responding to a rituximab-containing regimen. Bortezomib should be held for grade ≥2 treatment-related neuropathy. See text for suggested dosing, cycles, and scheduling of therapy. A clinical trial should be considered whenever possible.
