Initial Treatment of Waldenström Macroglobulinemia

Waldenström macroglobulinemia is a lymphoplasmacytic non-Hodgkin lymphoma characterized by the production of an immunoglobulin M (IgM) paraprotein and lack of a unified treatment approach. To assess the ability of a nonalkylating agent combination regimen to prevent an acute rise in IgM levels commonly seen during initial rituximab therapy, European investigators conducted an industry-supported, prospective, multicenter, phase II trial of intravenous bortezomib plus dexamethasone and rituximab in 59 previously untreated symptomatic patients (median age, 70; median IgM level, 3.9 mg/dL). Patients with preexisting grade 2 or higher peripheral neuropathy (PN) were excluded.

Patients received an initial 21-day cycle of bortezomib (1.3 mg/m² on d…