What constitutes refractory disease in the context of 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: What constitutes refractory disease in the context of Waldenstrom's Macroglobulinemia (WM)? This discussion also featured Christian Buske, Monique Minnema, Sheeba Koshy Thomas, and Jorge J. Castillo.

The panel begins by discussing disease manifestations and measurable parameters prior to, and posttreatment as well as the challenges of refractory disease not being clearly defined. Castillo mentions the contradictions of those patients who display symptom improvements but show no actual response in IgM levels, and vice versa, as this challenges the diagnosis of refractory disease. Sheeba highlights that patients on fixed-duration therapies who display progressive shortening of response duration until new symptoms appear/symptom reoccurrence could be added into the refractory disease group. Minnema highlights the value of defining an achievement goal for each patient, particularly for M-protein related diseases where numbers may be more important than clinical presentation. Lastly, Buske emphasizes the importance of not defining patients with refractory disease too early, as improvements are commonly expected after ending treatment; assessing patients in a case-by-case scenario is imperative.