Jul 2, 2019

A virtual roundtable discussion with noted investigators Prof Meletios A Dimopoulos and Dr Steven P Treon for a review of recent innovations in the treatment of Waldenström Macroglobulinemia.

• Pathophysiology, symptoms and common genetic mutations associated with Waldenström macroglobulinemia (WM) (00:00)
• Somatic mutations in MYD88 (L265P) and CXCR4 and implications for prognosis and therapy (1:46)
• Diagnostic criteria for WM (7:12)
• Case (Dr Treon): A man in his late 60s with WM experiences an IgM flare and worsening peripheral neuropathy during first-line treatment with rituximab (8:55)
• Indications for the initiation of therapy for patients with WM (12:02)
• Management approach for patients with WM experiencing IgM flare after treatment with rituximab (13:40)
• Activity of the Bruton tyrosine kinase (BTK) inhibitor ibrutinib alone or in combination with rituximab in patients with WM (15:35)
• Perspective on the use of ibrutinib with or without rituximab as front-line therapy for WM (17:51)
• Symptoms and management of hyperviscosity syndrome associated with WM (21:07)
• Role of obinutuzumab in the management of WM (23:58)
• Case (Prof Dimopoulos): A man in his early 50s with WM and a MYD88 L265P mutation attains a very good partial response to first-line therapy with bortezomib/dexamethasone/rituximab (25:24)
• Selection of therapy for patients with WM in the first-line setting (27:50)
• Efficacy and tolerability of proteasome inhibitors for WM (31:42)
• Peripheral neuropathy associated with WM and implications for therapy (34:39)
• Duration of ibrutinib therapy for WM and impact of treatment holidays (37:27)
• Side effects associated with ibrutinib; monitoring and management of atrial fibrillation (39:44)
• Case (Dr Treon): A woman in her mid-60s diagnosed with WM and a MYD88 L265P mutation experiences a dramatic response after receiving ibrutinib as first-line therapy (44:44)
• Response and tolerability with ibrutinib in the front-line setting (46:56)
• Case (Prof Dimopoulos): A woman in her early 80s with a history of hypertension and atrial fibrillation is diagnosed with WM with a MYD88 L265P mutation and receives ibrutinib and anticoagulation therapy (49:39)
• Perspective on the use of ibrutinib for elderly patients and those with a history of atrial fibrillation (51:37)
• Activity of the BTK inhibitor zanubrutinib in patients with WM (54:36)
• Results of the Phase III iNNOVATE trial evaluating ibrutinib with rituximab versus rituximab alone for patients with previously untreated or relapsed/refractory WM (56:19)
• Ongoing investigation of CXCR4 inhibitors and the Bcl-2 inhibitor venetoclax for WM (57:59)
• Biologic rationale and role for venetoclax in WM (1:00:28)
• Tumor lysis syndrome associated with venetoclax  (1:04:11)
• Novel agents and approaches under investigation for WM (1:05:26)
• Therapeutic options for patients with WM after disease progression on ibrutinib (1:06:56)

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