Report of consensus panel 2 from the 11th international workshop on Waldenström's macroglobulinemia on the management of relapsed or refractory WM patients

S. D'Sa*, J. V. Matous, R. Advani, C. Buske, J. J. Castillo, M. Gatt, P. Kapoor, M. J. Kersten, V. Leblond, M. Leiba, M. L. Palomba, J. Paludo, L. Qiu, S. Sarosiek, M. Shadman, D. Talaulikar, C. S. Tam, A. Tedeschi, S. K. Thomas, I. Tohidi-EsfahaniJ. Trotman, M. Varettoni, J. M.I. Vos, R. Garcia-Sanz, J. San-Miguel, M. A. Dimopoulos, S. P. Treon, E. Kastritis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

The consensus panel 2 (CP2) of the 11th International Workshop on Waldenström's macroglobulinemia (IWWM-11) has reviewed and incorporated current data to update the recommendations for treatment approaches in patients with relapsed or refractory WM (RRWM). The key recommendations from IWWM-11 CP2 include: (1) Chemoimmunotherapy (CIT) and/or a covalent Bruton tyrosine kinase (cBTKi) strategies are important options; their use should reflect the prior upfront strategy and are subject to their availability. (2) In selecting treatment, biological age, co-morbidities and fitness are important; nature of relapse, disease phenotype and WM-related complications, patient preferences and hematopoietic reserve are also critical factors while the composition of the BM disease and mutational status (MYD88, CXCR4, TP53) should also be noted. (3) The trigger for initiating treatment in RRWM should utilize knowledge of patients’ prior disease characteristics to avoid unnecessary delays. (4) Risk factors for cBTKi related toxicities (cardiovascular dysfunction, bleeding risk and concurrent medication) should be addressed when choosing cBTKi. Mutational status (MYD88, CXCR4) may influence the cBTKi efficacy, and the role of TP53 disruptions requires further study) in the event of cBTKi failure dose intensity could be up titrated subject to toxicities. Options after BTKi failure include CIT with a non-cross-reactive regimen to one previously used CIT, addition of anti-CD20 antibody to BTKi, switching to a newer cBTKi or non-covalent BTKi, proteasome inhibitors, BCL-2 inhibitors, and new anti-CD20 combinations are additional options. Clinical trial participation should be encouraged for all patients with RRWM.

Original languageAmerican English
Pages (from-to)80-89
Number of pages10
JournalSeminars in Hematology
Volume60
Issue number2
DOIs
StatePublished - Mar 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

  • BTK inhibitors
  • CXCR4
  • Chemoimmunotherapy
  • MYD88
  • TP53
  • Waldenström macroglobulinemia

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