How and when to treat patients with refractory or progressive WM

On behalf of the International Waldenstrom's Macroglobulinemia Foundation (IWMF), the Lymphoma Hub was pleased to speak with Stephen Ansell, Mayo Clinic, Rochester, US, who chaired a discussion on, How and when to treat patients with refractory or progressive Waldenstrom's macroglobulinemia (WM)? This discussion also featured Christian Buske, Monique Minnema, Sheeba Koshy Thomas, and Jorge J. Castillo.

Minnema begins by discussing why treatment should only be restarted after measuring each individual patient’s IgM level, a vital indicator of disease progression. Both Minnema and Thomas place importance on the return of symptoms being a useful gauge to assess whether treatment should be restarted. Castillo remarks that readministering a prior regimen is a viable approach only if patients achieve durable responses and treatment is tolerated; however, in cases of relapsed disease, treatment with a different mechanism of action is often the next step. For example, treatment with chemoimmunotherapy and Bruton’s tyrosine kinase (BTK) inhibitors could be used as first and second-line treatments, respectively. Castillo also highlights BTK inhibitors as good follow-up therapy options. Finally, Buske covers novel treatment options following progression on ibrutinib, including the use of a non-covalent BTK inhibitors such as pirtobrutinib, immunochemotherapy, or venetoclax.