EBMT 2018 | Lymphoma Working Party consensus on defining the role of ASCT and allo-SCT in WM

An oral session on lymphoma took place at the 44^th European Society for Blood and Marrow Transplantation (EBMT) annual meeting on 19 March 2018. Abstract OS1-1 was presented by Charalampia Kyriakou, hematology consultant from the Royal Free London NHS foundation, who discussed the outcomes of a consensus on the role of autologous stem cell transplantation (ASCT) and allogeneic stem cell transplantation (allo-SCT) in Waldenström’s macroglobulinemia (WM).

The consensus was produced by international experts from the EBMT lymphoma working party (LWP), European Consortium for Waldenstrom’s Macroglobulinemia (ECWM) and International Waldenström’s Macroglobulinemia Foundation (IWMF) using the RAND-modified Delphi consensus method. Dr Kyriakou highlighted that the panel included European and North American lymphoma and transplant experts to take into account the difference of access to drugs in these countries. 

The experts aimed to address a gap in the knowledge of the role of transplantation in WM however, the main challenge was the lack of evidence in such a rare disease. Eighteen statements were prepared and scored by the members and a consensus was successfully agreed on nine of the statements.

Key Consensus Outcomes

• The consensus agreed that the role of ASCT could be considered as a treatment option for patients with more than two relapses and chemo-sensitive disease
• ASCT was considered inappropriate as part of first-line therapy for WM patients who are responding to their initial therapy and also to B-cell receptor inhibitors (BCRi)
• If patients have potential to receive transplant in the future, the consensus agreed that stem cell-toxic agents should be avoided in first-line therapy
• Allo-SCT can be considered after patients have relapsed from ASCT and also in high-risk patients with more than 3 relapses and who are also refractory to immunochemotherapy and BCRi
• The consensus agreed that a patient should not receive allo-SCT if a patient has not previously tried BCRi or if it is an available treatment option
• No consensus was reached on the storage of autologous stem cells for future use in younger patients under sixty-years old

Dr Kyriakou stressed that, “it is important we individualize this treatment in this rare group of patients because we are not clear on the risk factors of this disease and also the clinical cause.” The consensus was also able to “identify areas of uncertainty for further research”.