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Maintenance Therapy for Waldenstrom: Necessary or Not?

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Published on January 20, 2020

Key Takeaways

  • Maintenance therapy after chemotherapy may not be beneficial in the treatment of Waldenstrom.
  • A new scoring system can help predict how patients will respond to ibrutinib.
  • Clinical trials for lymphoma and myeloma are starting to include Waldenstrom patients—preliminary results look promising.

“We can probably feel a lot more confident about just stopping after their initial therapy,” says Dr. Larry Anderson as he explains that a recent study debunked the widely-held belief that two years of maintenance therapy benefits Waldenstrom macroglobulinemia patients who have first been treated with chemotherapy. Dr. Anderson, an expert from UT Southwestern Medical Center, joined Patient Power at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition to share this and other emerging news, including the advent of a revolutionary new scoring system that may be able to predict how Waldenstrom patients will react to ibrutinib (Imbruvica). Watch now to learn more from a Waldenstrom expert.

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Transcript | Maintenance Therapy for Waldenstrom: Necessary or Not?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Theresa (Clementi) Doan:

Is there any emerging research that you're excited about to hear for Waldenstrom's?  

Dr. Anderson:

Yes.  So there are a few things here at ASH that relate to Waldenstrom's, and I think one of the critical abstracts here sort of answers a question that we've had in patients that have gone through their initial therapy for Waldenstrom's, what do we do after that?  Do we need to do maintenance therapy and keep them on monoclonal antibodies for two years or not?  There's some data that showed that that had appeared promising giving two years of maintenance therapy. 

Now there's a randomized study presented here at ASH that shows that after their initial bendamustine plus rituximab (Treanda plus Rituxan) therapy the two years of maintenance did not help improve progression‑free survival or overall survival in those patients with Waldenstrom's, so we could probably feel a lot more confident about just stopping after their initial therapy unless they have other reasons for needing to go on something different at that point. 

Theresa (Clementi) Doan:

Wow.  That's wonderful to hear.  So, it's always nice to hear that you can stop treatment and you'll be good. Great. 

Dr. Anderson:

And that being said, that's after chemotherapy, whereas after just rituximab alone we don't necessarily have data in that situation. 

Theresa (Clementi) Doan:

Maybe in the future.  

Dr. Anderson:

Yeah. Exactly. Hopefully, future studies will shed light on that.  

Another key piece of information here presented at ASH is what sort of factors can help predict how patients will do with that oral therapy called ibrutinib (Imbruvica).  And so, one of the studies has looked at a scoring system for just two pieces of information, how low is their albumin, their blood test called albumin.  If it's low, those patients have shorter time to relapse.  And also if they have mutation of a gene in their Waldenstrom's cells called CXCR4, those patients have shorter time to relapse, and if they have both of those factors that they have the shortest time to relapse, so probably need to have something augmenting that therapy, combinations or newer therapies. 

Theresa (Clementi) Doan:

Okay.  Great.  And the scoring system, can patients do that on their own and bring it to their doctor, or how does that work? 

Dr. Anderson:

Yeah.  Basically, it's just those two pieces of information, whether their albumin is below 3.5 and whether or not they have CXCR4 mutation, and either zero, one or two of those can help stratify patients. 

Theresa (Clementi) Doan:

Wonderful.  Well, that's great to hear.  Is there anything else that you're excited about from ASH?  

Dr. Anderson:

I think a lot of the things that we're seeing in lymphoma in general, so you could think of Waldenstrom's as a rare subtype of lymphoma, so some of the studies with CAR‑T cells and other immunotherapies are starting to include at least a few patients with Waldenstrom's, and those preliminary results look encouraging.  So, I think a lot of the exciting things that we're using to treat myeloma and lymphoma will be gradually carried over into Waldenstrom's. 

Theresa (Clementi) Doan:

Great.  So Waldenstrom's patients can look at data for other myeloma patients in lymphoma too and kind of be hopeful that it's going to come their way as well. 

Dr. Anderson:

Right.  A lot of their Waldenstrom's cells will express the same targets, for example CD20 for the lymphoma space and then BCMA for the myeloma therapy space as well.  

Theresa (Clementi) Doan:

Well, wonderful.  Thank you so much for your time, Dr. Anderson.  We really appreciate it.  

Dr. Anderson:

Glad to be here.  

Theresa (Clementi) Doan:

Thank you.  From ASH, I'm Theresa from Patient Power.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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