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[Complete response achieved after rituximab plus CHOP therapy in a patient with rapidly progressing Waldenstrom's
Mikiko Ise1, Chikara Sakai, Kyoya Kumagai
1Division of Hematology-Oncology, Chiba Cancer Center.
Insights
Rituximab in combination with CHOP therapy (R-CHOP) achieved a complete response in a patient with aggressive Waldenstrom's macroglobulinemia (WM). This combination therapy demonstrated effectiveness and tolerability for aggressive WM cases.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Waldenstrom's macroglobulinemia (WM) is a rare lymphoproliferative disorder characterized by IgM monoclonal gammopathy.
- Aggressive forms of WM often present with high tumor burden and poor prognostic indicators, necessitating effective treatment strategies.
Observation:
- A 62-year-old male presented with symptomatic WM, including lymphocytosis, anemia, thrombocytopenia, lymphadenopathy, splenomegaly, and markedly elevated serum IgM.
- Initial CHOP chemotherapy led to partial improvement, but subsequent addition of rituximab (R-CHOP) resulted in complete resolution of disease manifestations.
Findings:
- The patient achieved a complete response (CR) with R-CHOP therapy, evidenced by the disappearance of bone marrow infiltration, lymphadenopathy, splenomegaly, and undetectable serum IgM monoclonal protein.
- Serum levels of soluble interleukin-2 receptor and beta2-microglobulin, markers of tumor burden, normalized post-treatment.
- The patient remained in CR for at least 12 months, indicating durable efficacy.
Implications:
- R-CHOP therapy represents a highly effective and tolerable treatment option for aggressive Waldenstrom's macroglobulinemia.
- This case highlights the potential of R-CHOP to achieve complete responses, which are infrequently observed with other combination chemotherapy regimens in WM.
- Further investigation into R-CHOP for aggressive WM is warranted given these promising results.
Abstract:
A 62-year-old man presented with lymphocytosis, anemia, thrombocytopenia, abdominal lymphadenopathies, and gross splenomegaly. He had a high serum immunoglobulin M (IgM) of 1,150 mg/dl and IgM-kappa type monoclonal protein was detected. Bone marrow examination demonstrated massive infiltration of CD19+CD20+CD5-CD10-CD23-lymphoplasmacytic cells, and the diagnosis of Waldenstrom's macroglobulinemia (WM) was made. The serum levels of soluble interleukin-2 receptor and beta2-microglobulin were also elevated to 14,300 U/ml and 6.2 mg/l, respectively. The high tumor burden and aggressive clinical features prompted the initiation of CHOP therapy. After three courses of CHOP, the patient recovered from anemia and the serum IgM level decreased to 615 mg/dl. Then we administered rituximab in combination with CHOP (R-CHOP therapy). After an additional five courses of R-CHOP, bone marrow tumor cells, splenomegaly and lymphadenopathies entirely disappeared and IgM-type monoclonal protein also became negative on immunofixation studies. Thus, a complete response (CR) was achieved and the patient has remained in CR for 12 months. Although new therapeutic options for WM including combination chemotherapy have recently been explored, complete response rates defined by immunofixation remain low. Our case indicates that R-CHOP therapy is fully effective and tolerable for aggressive type WM.