Blood Res 2018; 53(2):
Published online June 25, 2018
https://doi.org/10.5045/br.2018.53.2.117
© The Korean Society of Hematology
1Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
2Clinical Research Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
3Pharmaceutical Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
4Laboratory and Pathology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
5Clinical Oncology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
Correspondence to : Naohiro Sekiguchi, M.D., Ph.D. Hematology Division, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan. nao26nao26@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Waldenström Macroglobulinemia (WM) is a rare subtype of indolent B-cell lymphoma, and prospective randomized studies on WM are scarce. The R-CHOP therapy [rituximab (R), cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone] is a popular and recommended regimen for primary therapy, prescribed by several treatment guidelines for WM. However, treatment with R-CHOP is accompanied by severe myelosuppression and high rates of peripheral neuropathy. Therefore, we retrospectively evaluated the efficacy and toxicity of half-dose CHOP combined with R as a primary therapy for WM.
Patients with untreated symptomatic WM, treated at the Disaster Medical Center between April 2011 and September 2016, were retrospectively analyzed after administration of 6 cycles of half-dose R-CHOP for every 3 weeks. The response, median time to response, best response, progression-free survival, overall survival, and toxicities were evaluated.
Of the 20 WM patients analyzed, 16 (80%) received half-dose R-CHOP without vincristine, and 13 (65%) responded to the treatment. With a median follow-up duration of 26.3 months, the 2-year progression-free survival and 2-year overall survival rates were 70 and 93.3%, respectively. The median time to response and best response were 6 and 9.9 weeks, respectively. Grade 3/4 leukocytopenia, neutropenia, febrile neutropenia, and Grade 1 peripheral neuropathy developed in 32, 37, 0, and 21% of patients, respectively.
The half-dose R-CHOP is an effective and well-tolerated primary therapy for WM. To the best of our knowledge, this is the first study reporting the use of a reduced-dose R-CHOP regimen for the primary treatment of WM.
Keywords Waldenström Macroglobulinemia, R-CHOP, Reduced-dose, Primary therapy
Blood Res 2018; 53(2): 117-122
Published online June 25, 2018 https://doi.org/10.5045/br.2018.53.2.117
Copyright © The Korean Society of Hematology.
Naohiro Sekiguchi1,2*, Airi Hamano3, Tomoko Kitagawa2, Yuya Kurihara1, Kenichi Ito1, Miwa Kurimoto1, Kozo Watanabe3, Kazuhiko Hirano4, Satoshi Noto5, Kazuaki Yamada4, and Naoki Takezako1
1Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
2Clinical Research Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
3Pharmaceutical Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
4Laboratory and Pathology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
5Clinical Oncology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
Correspondence to:Naohiro Sekiguchi, M.D., Ph.D. Hematology Division, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan. nao26nao26@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Waldenström Macroglobulinemia (WM) is a rare subtype of indolent B-cell lymphoma, and prospective randomized studies on WM are scarce. The R-CHOP therapy [rituximab (R), cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone] is a popular and recommended regimen for primary therapy, prescribed by several treatment guidelines for WM. However, treatment with R-CHOP is accompanied by severe myelosuppression and high rates of peripheral neuropathy. Therefore, we retrospectively evaluated the efficacy and toxicity of half-dose CHOP combined with R as a primary therapy for WM.
Patients with untreated symptomatic WM, treated at the Disaster Medical Center between April 2011 and September 2016, were retrospectively analyzed after administration of 6 cycles of half-dose R-CHOP for every 3 weeks. The response, median time to response, best response, progression-free survival, overall survival, and toxicities were evaluated.
Of the 20 WM patients analyzed, 16 (80%) received half-dose R-CHOP without vincristine, and 13 (65%) responded to the treatment. With a median follow-up duration of 26.3 months, the 2-year progression-free survival and 2-year overall survival rates were 70 and 93.3%, respectively. The median time to response and best response were 6 and 9.9 weeks, respectively. Grade 3/4 leukocytopenia, neutropenia, febrile neutropenia, and Grade 1 peripheral neuropathy developed in 32, 37, 0, and 21% of patients, respectively.
The half-dose R-CHOP is an effective and well-tolerated primary therapy for WM. To the best of our knowledge, this is the first study reporting the use of a reduced-dose R-CHOP regimen for the primary treatment of WM.
Keywords: Waldenström Macroglobulinemia, R-CHOP, Reduced-dose, Primary therapy
Table 1 .
Abbreviations: IPSSWM, International Prognostic Scoring System for Waldenstroöm Macroglobulinemia; LLN, lower limit of normal; PS, performance status; ULN, upper limit of normal..
Table 2 .
Each number indicates numbers of cases who suffering from each toxicity..
Table 3 .
Abbreviations: DRC, dexamethasone, rituximab, and cyclophosphamide; FN, febrile neutropenia; G, grade; M, median; NA, not applicable; ORR, overall response rate; PFS, progression-free survival; PN, peripheral neuropathy; R-CHOP, rituximab, cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone; Ref No., reference number; TTF, time to treatment failure; TTP, time to progression..
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