Frontline therapeutic options for Waldenström macroglobulinemia
Therapeutic class and agents* . | Evidence for efficacy21 . | Level of recommendation21 . |
|---|---|---|
| Alkylator agents | ||
| Chlorambucil | IIa | B |
| Nucleoside analogs | ||
| Cladribine or fludarabine | IIa | B |
| Monoclonal antibody | ||
| Rituximab (standard or extended schedule) | IIa | B |
| Nucleoside analogs plus alkylators | ||
| Cladribine or fludarabine plus cyclophosphamide | IIa | B |
| Nucleoside analogs plus rituximab | ||
| Fludarabine plus rituximab | IIa | B |
| Nucleoside analogs plus alkylators and rituximab | ||
| Cladribine, cyclophosphamide, and rituximab | IIa | B |
| Fludarabine, cyclophosphamide, and rituximab | III | C |
| Pentostatin, cyclophosphamide, and rituximab | III | C |
| Combination chemotherapy plus rituximab | ||
| CHOP and rituximab | IIa | B |
| Cyclophosphamide, dexamethasone, and rituximab | IIa | B |
Therapeutic class and agents* . | Evidence for efficacy21 . | Level of recommendation21 . |
|---|---|---|
| Alkylator agents | ||
| Chlorambucil | IIa | B |
| Nucleoside analogs | ||
| Cladribine or fludarabine | IIa | B |
| Monoclonal antibody | ||
| Rituximab (standard or extended schedule) | IIa | B |
| Nucleoside analogs plus alkylators | ||
| Cladribine or fludarabine plus cyclophosphamide | IIa | B |
| Nucleoside analogs plus rituximab | ||
| Fludarabine plus rituximab | IIa | B |
| Nucleoside analogs plus alkylators and rituximab | ||
| Cladribine, cyclophosphamide, and rituximab | IIa | B |
| Fludarabine, cyclophosphamide, and rituximab | III | C |
| Pentostatin, cyclophosphamide, and rituximab | III | C |
| Combination chemotherapy plus rituximab | ||
| CHOP and rituximab | IIa | B |
| Cyclophosphamide, dexamethasone, and rituximab | IIa | B |
Information has been updated from the original consensus panel recommendations of the Second International Workshop on Waldenström's Macroglobulinemia.4
The choice of appropriate therapy should take into account the candidacy of a patient for high-dose chemotherapy since prolonged use of both alkylating agents and nucleoside analogs can deplete hematopoietic stem cells.