This protocol addresses primary systemic therapy for patients with a confirmed diagnosis of Waldenstrom's macroglobulinemia (WM) or lymphoplasmacytic lymphoma (LPL) who are symptomatic and meet criteria for treatment initiation.
Multiple preferred primary therapy options are recognised, spanning combination chemoimmunotherapy and targeted therapy approaches. A further set of regimens is available as other recommended options for specific clinical circumstances.
Treatment success is measured by reduction in the serum IgM protein. A minor response requires at least a 25% reduction; a partial response requires at least 50%; a very good partial response requires at least 90%. The primary aims are symptom relief and reducing the risk of organ damage.
DOI: 10.6004/jnccn.2024.0001
According to the NCCN WM/LPL Panel, treatment should be initiated for patients with a diagnosis of WM/LPL only in those who are symptomatic.
The NCCN Panel has included ibrutinib with or without rituximab as a preferred regimen for primary therapy (category 1).
The NCCN Panel has included zanubrutinib as a preferred regimen for primary therapy (category 1).
Response to therapy in WM is defined by reduction in the IgM protein.
According to the updated summary of response categories from the Eleventh International Workshop on WM, a minor response is an IgM reduction of at least 25%; a PR is defined as a ≥50% reduction in IgM immunoglobulin; a VGPR is a ≥90% reduction in IgM immunoglobulin; and a CR is immunofixation negativity in the serum along with resolution of extramedullary disease and clearance of the bone marrow.
The goal of treatment is symptom relief and reducing the risk of organ damage.
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