A Canadian Perspective on the Treatment of Waldenström Macroglobulinemia.

Waldenström macroglobulinemia (WM) is a slowly progressing B-cell non-Hodgkin lymphoma characterized by monoclonal IgM gammopathy in the blood and infiltration of the bone marrow by clonal lymphoplasmacytic cells. As an incurable disease, the goals for therapy for WM are to relieve symptoms, slow disease progression, prevent organ damage, and maintain quality of life. However, given the rarity of WM, clinical trials comparing treatments for WM are limited and there is no definitive standard of care. The selection of first-line WM therapy is thus based on patient factors, disease characteristics, and drug access, with bendamustine-rituximab and Bruton's tyrosine kinase (BTK) inhibitor therapy considered preferred treatments. Other treatments such as proteasome inhibitor- or purine analogue-based therapy, alternative chemoimmunotherapy, and autologous stem cell transplantation are generally reserved for the relapsed setting but may be used in rare circumstances in earlier lines of therapy. This paper summarizes the efficacy and safety of these WM therapies and discusses considerations for treatment from a Canadian perspective.

Déclaration de conflit d'intérêts

R.K. has received honoraria from Janssen, BMS, Beigene, Sanofi, FORUS. N.F. has received honoraria from Pfizer and AstraZeneca; served in a consulting or advisory role for AbbVie, AstraZeneca, Beigene, Celgene/Bristol Meyers Squibb, IMV, Janssen, Kite/Gilead, Novartis, Pfizer, Roche, Seattle Genetics, and Servier; received research funding from ADC Therapeutics, AstraZeneca, Astellas, IMV, Merk, MorphoSys, and Seattle Genetics. L.H.S. has received honoraria from Amgen, Apobiologix, AbbVie, Celgene, Gilead Sciences, Janssen-Ortho, Karyopharm Therapeutics, Kite, a Gilead company, Lundbeck, Merck, Roche/Genentech, Seattle Genetics, Takeda, Teva, TG Therapeutics, AstraZeneca, Acerta Pharma, Morphosys, Incyte, Debiopharm Group, Sandoz-Novartis, Verastem, and Genmab; served in a consulting or advisory role for Celgene, AbbVie, Seattle Genetics, TG Therapeutics, Janssen, Amgen, Roche/Genentech, Gilead Sciences, Lundbeck, Amgen, apobiologix, Karyopharm Therapeutics, Kite, a Gilead company, Merck, Takeda, Teva, TG therapeutics, AstraZeneca, Acerta Pharma, MorphoSys, Incyte, Debiopharm Group, Sandoz-Novartis, Genmab, and Verastem; and received institutional research funding from Roche Genentech and Teva. M.S. has received honoraria from AstraZeneca, BeiGene, Janssen; and has participated in research trials with AstraZeneca. S.D. has received funding from BeiGene Inc. for medical writing services. C.I.C. has received research funding from Bristol Meyers Squibb and Gilead; and has served in a consulting or advisory role for Abbvie, BeiGene, Bristol Meyers Squibb, Gilead, and Novartis.