Treatment of patients with Waldenström macroglobulinaemia: clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group

Dipti Talaulikar; Douglas Joshua; Phoebe Joy Ho; John Gibson; Hang Quach; Simon Gibbs; Silvia Ling; Christopher Ward; Bradley M Augustson; Judith Trotman; Simon J Harrison; Constantine S Tam; Medical and Scientific Advisory Group, Myeloma Australia

doi:10.1111/imj.15980

Treatment of patients with Waldenström macroglobulinaemia: clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group

Intern Med J. 2023 Apr;53(4):599-609. doi: 10.1111/imj.15980. Epub 2023 Apr 5.

Authors

Dipti Talaulikar^{1

2}, Douglas Joshua³, Phoebe Joy Ho^{3

4}, John Gibson^{3

4}, Hang Quach^{5

6}, Simon Gibbs^{7

8}, Silvia Ling⁹, Christopher Ward¹⁰, Bradley M Augustson¹¹, Judith Trotman^{4

12}, Simon J Harrison^{13

14}, Constantine S Tam^{6

15

16}; Medical and Scientific Advisory Group, Myeloma Australia

Affiliations

¹ ACT Pathology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
² College of Health and Medicine, Australian National University, Australian Capital Territory, Canberra, Australia.
³ Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁴ University of Sydney, Sydney, New South Wales, Australia.
⁵ St Vincent's Hospital, Melbourne, Victoria, Australia.
⁶ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Department of Haematology, Eastern Health, Melbourne, Victoria, Australia.
⁸ Eastern Clinical Research Unit, Monash University, Melbourne, Victoria, Australia.
⁹ Liverpool Hospital, Sydney, New South Wales, Australia.
¹⁰ Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹¹ Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
¹² Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
¹³ Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
¹⁴ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia, Australia.
¹⁵ Alfred Hospital, Melbourne, Australia, Australia.
¹⁶ Central Clinical School, Monash University, Melbourne, Australia, Australia.

PMID: 36441109
DOI: 10.1111/imj.15980

Abstract

Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of IgM paraprotein, bone marrow infiltration by clonal small B lymphocytes with plasmacytic differentiation and the MYD88 L265P mutation in >90% of cases. Traditionally, WM has been treated with chemoimmunotherapy. Recent trials have demonstrated the efficacy and safety of Bruton tyrosine kinase inhibitors in WM, both as monotherapy and in combination with other drugs. There is emerging evidence on the use of other agents including B-cell lymphoma 2 inhibitors and on the treatment of rare presentations of WM. In this update, the Medical and Scientific Advisory Group of Myeloma Australia reviews the available evidence on the treatment of WM since the last publication in 2017 and provides specific recommendations to assist Australian clinicians in the management of this disease.

Keywords: Bruton tyrosine kinase inhibitor; Waldenström macroglobulinaemia; treatment.

MeSH terms

Antineoplastic Agents* / therapeutic use
Australia / epidemiology
Bone Marrow / pathology
Humans
Multiple Myeloma* / drug therapy
Mutation
Myeloid Differentiation Factor 88 / genetics
Waldenstrom Macroglobulinemia* / diagnosis
Waldenstrom Macroglobulinemia* / drug therapy
Waldenstrom Macroglobulinemia* / genetics

Substances

Antineoplastic Agents
Myeloid Differentiation Factor 88