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Comparative outcomes of immunochemotherapy regimens in Waldenström macroglobulinaemia
Author(s) -
Olszewski Adam J.,
Chen Chang,
Gutman Roee,
Treon Steven P.,
Castillo Jorge J.
Publication year - 2017
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14828
Subject(s) - rituximab , medicine , waldenstrom macroglobulinemia , hazard ratio , oncology , confidence interval , population , plasmapheresis , cohort , lymphoma , immunology , antibody , environmental health
Summary Comparative data on immunochemotherapy regimens for Waldenström macroglobulinaemia/lymphoplasmacytic lymphoma ( WM / LPL ) are lacking. We analysed overall survival ( OS ), risk of hospitalizations, transfusions and plasmapheresis in a population‐based cohort of patients ≥65 years old initiating WM / LPL therapy in 1999–2013. To minimize bias, we applied a propensity score‐based causal inference method. We conducted three analyses of: patients treated with or without rituximab, patients treated with rituximab monotherapy or with combination immunochemotherapy, and regimens based on classic purine analogues or alkylators. Among 1310 patients, 78·5% received rituximab. Patients who received rituximab had significantly better OS [hazard ratio ( HR ) 0·62, 95% confidence interval ( CI ) 0·55–0·71] and lower risk of transfusions (risk difference −3·3%, 95% CI −6·3 to −0·3) than those who did not, without a significant difference in hospitalizations or plasmapheresis. We observed no significant difference in OS ( HR 0·91, 95% CI 0·79–1·04) between rituximab monotherapy and combination immunochemotherapy, but toxicity outcomes were lower with rituximab alone. Neither survival ( HR 1·10, 95% CI 0·92–1·32) nor toxicity outcomes differed significantly between regimens based on purine analogues or alkylators. The survival advantage strongly supports rituximab as part of upfront therapy for WM / LPL , whereas regimens with either purine analogues or alkylating agents result in similar outcomes.