Treatment of patients with Waldenström macroglobulinaemia: clinical practice guidelines from the Myeloma Foundation of Australia Medical and Scientific Advisory Group

Dipti Talaulikar, Constantine S Tam, Douglas Edgar Joshua, Phoebe Joy Ho, Jeff Szer, Hang Quach, Andrew Spencer, Simon James Harrison, Peter Mollee, Andrew W. Roberts, Noemi Horvath, Cindy Lee, Andrew C W Zannettino, Ross D Brown, Bradley M Augustson, Wilfrid J Jaksic, John Gibson, Anna Kalff, Anna Johnston, Judith Trotman & 4 others Akash Kalro, George Grigoriadis, Chris Ward, H. Miles Prince

Research output: Contribution to journalArticleOtherpeer-review

Abstract

Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of immunoglobulin M (IgM) paraprotein and bone marrow infiltration by clonal small B lymphocytes, plasmacytoid lymphocytes and plasma cells. The symptoms of WM are protean, often follow an asymptomatic phase and may include complications related to the paraneoplastic effects of IgM paraprotein. The revised 2016 World Health Organization classification includes the MYD88 L265P mutation, which is seen in >90% of cases, within the diagnostic criteria for WM. While treatment of WM has often been considered together with other indolent B cell lymphomas, there are unique aspects of WM management that require specific care. These include the unreliability of IgM and paraprotein measurements in monitoring patients prior to and after treatment, the lack of correlation between disease burden and symptoms and rituximab-induced IgM flare. Moreover, while bendamustine and rituximab has recently been approved for reimbursed frontline use in WM in Australia, other regimens, including ibrutinib- and bortezomib-based treatments, are not funded, requiring tailoring of treatment to the regional regulatory environment. The Medical and Scientific Advisory Group of the Myeloma Foundation Australia has therefore developed clinical practice guidelines with specific recommendations for the work-up and therapy of WM to assist Australian clinicians in the management of this disease.

Original languageEnglish
Pages (from-to)35-49
Number of pages15
JournalInternal Medicine Journal
Volume47
Issue number1
DOIs
Publication statusPublished - 1 Jan 2017

Keywords

  • ibrutinib, bendamustine
  • lymphoplasmacytic lymphoma
  • monoclonal gammopathy of undetermined significance
  • rituximab
  • Waldenström macroglobulinaemia

Cite this

Talaulikar, Dipti ; Tam, Constantine S ; Joshua, Douglas Edgar ; Ho, Phoebe Joy ; Szer, Jeff ; Quach, Hang ; Spencer, Andrew ; Harrison, Simon James ; Mollee, Peter ; Roberts, Andrew W. ; Horvath, Noemi ; Lee, Cindy ; Zannettino, Andrew C W ; Brown, Ross D ; Augustson, Bradley M ; Jaksic, Wilfrid J ; Gibson, John ; Kalff, Anna ; Johnston, Anna ; Trotman, Judith ; Kalro, Akash ; Grigoriadis, George ; Ward, Chris ; Prince, H. Miles. / Treatment of patients with Waldenström macroglobulinaemia : clinical practice guidelines from the Myeloma Foundation of Australia Medical and Scientific Advisory Group. In: Internal Medicine Journal. 2017 ; Vol. 47, No. 1. pp. 35-49.
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abstract = "Waldenstr{\"o}m macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of immunoglobulin M (IgM) paraprotein and bone marrow infiltration by clonal small B lymphocytes, plasmacytoid lymphocytes and plasma cells. The symptoms of WM are protean, often follow an asymptomatic phase and may include complications related to the paraneoplastic effects of IgM paraprotein. The revised 2016 World Health Organization classification includes the MYD88 L265P mutation, which is seen in >90{\%} of cases, within the diagnostic criteria for WM. While treatment of WM has often been considered together with other indolent B cell lymphomas, there are unique aspects of WM management that require specific care. These include the unreliability of IgM and paraprotein measurements in monitoring patients prior to and after treatment, the lack of correlation between disease burden and symptoms and rituximab-induced IgM flare. Moreover, while bendamustine and rituximab has recently been approved for reimbursed frontline use in WM in Australia, other regimens, including ibrutinib- and bortezomib-based treatments, are not funded, requiring tailoring of treatment to the regional regulatory environment. The Medical and Scientific Advisory Group of the Myeloma Foundation Australia has therefore developed clinical practice guidelines with specific recommendations for the work-up and therapy of WM to assist Australian clinicians in the management of this disease.",
keywords = "ibrutinib, bendamustine, lymphoplasmacytic lymphoma, monoclonal gammopathy of undetermined significance, rituximab, Waldenstr{\"o}m macroglobulinaemia",
author = "Dipti Talaulikar and Tam, {Constantine S} and Joshua, {Douglas Edgar} and Ho, {Phoebe Joy} and Jeff Szer and Hang Quach and Andrew Spencer and Harrison, {Simon James} and Peter Mollee and Roberts, {Andrew W.} and Noemi Horvath and Cindy Lee and Zannettino, {Andrew C W} and Brown, {Ross D} and Augustson, {Bradley M} and Jaksic, {Wilfrid J} and John Gibson and Anna Kalff and Anna Johnston and Judith Trotman and Akash Kalro and George Grigoriadis and Chris Ward and Prince, {H. Miles}",
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Talaulikar, D, Tam, CS, Joshua, DE, Ho, PJ, Szer, J, Quach, H, Spencer, A, Harrison, SJ, Mollee, P, Roberts, AW, Horvath, N, Lee, C, Zannettino, ACW, Brown, RD, Augustson, BM, Jaksic, WJ, Gibson, J, Kalff, A, Johnston, A, Trotman, J, Kalro, A, Grigoriadis, G, Ward, C & Prince, HM 2017, 'Treatment of patients with Waldenström macroglobulinaemia: clinical practice guidelines from the Myeloma Foundation of Australia Medical and Scientific Advisory Group' Internal Medicine Journal, vol. 47, no. 1, pp. 35-49. https://doi.org/10.1111/imj.13311

Treatment of patients with Waldenström macroglobulinaemia : clinical practice guidelines from the Myeloma Foundation of Australia Medical and Scientific Advisory Group. / Talaulikar, Dipti; Tam, Constantine S; Joshua, Douglas Edgar; Ho, Phoebe Joy; Szer, Jeff; Quach, Hang; Spencer, Andrew; Harrison, Simon James; Mollee, Peter; Roberts, Andrew W. ; Horvath, Noemi; Lee, Cindy; Zannettino, Andrew C W; Brown, Ross D; Augustson, Bradley M; Jaksic, Wilfrid J; Gibson, John; Kalff, Anna; Johnston, Anna; Trotman, Judith; Kalro, Akash; Grigoriadis, George; Ward, Chris; Prince, H. Miles.

In: Internal Medicine Journal, Vol. 47, No. 1, 01.01.2017, p. 35-49.

Research output: Contribution to journalArticleOtherpeer-review

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AU - Brown, Ross D

AU - Augustson, Bradley M

AU - Jaksic, Wilfrid J

AU - Gibson, John

AU - Kalff, Anna

AU - Johnston, Anna

AU - Trotman, Judith

AU - Kalro, Akash

AU - Grigoriadis, George

AU - Ward, Chris

AU - Prince, H. Miles

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