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 AgeMedian Prior TherapiesBone Marrow InvolvementsIgM (mg/dL)HctPLTB2M
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 AgeMedian Prior TherapiesBone Marrow InvolvementsIgM (mg/dL)HctPLTB2M
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 
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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)≥PRCR/nCR% decrease sIgMPost-sIgMPost-HctPost-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)≥PRCR/nCR% decrease sIgMPost-sIgMPost-HctPost-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 
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Adverse events attributed to therapy, including rituximab related IgM flare were as follows:

Neutropenic feverHospitalizationsTreatment related neuropathyIgM flareIgM 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 feverHospitalizationsTreatment related neuropathyIgM flareIgM 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% 
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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.

Topics:
r-chop, waldenstrom macroglobulinemia, immunoglobulin m, cardiopulmonary resuscitation, febrile neutropenia, neuropathy, rituximab, adverse event, bone marrow involvement, cyclophosphamide

Disclosures: No relevant conflicts of interest to declare.

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2008, The American Society of Hematology
2008
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