Comparative efficacy of triple combination therapies containing either bortezomib or rituximab in treatment- na?ve patients with lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)

Purpose: To evaluate the comparative efficacy of triple combination therapies of cyclophosphamide/dexamethasone containing either bortezomib or rituximab in treatment-naive patients diagnosed with lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia, LPL/WM).Methods: Symptomatic, untreated patients with LPL/WM diagnosed in the First Affiliated Hospital of Soochow University were enrolled in this study and divided into two groups (BCD and RCD). Group BCD consisted of 16 patients administered bortezomib/cyclophosphamide/dexamethasone, while group RCD (15 patients) received rituximab/cyclophosphamide/dexamethasone. The efficacy of the two therapies and the Kaplan-Meier survival curve of the groups were evaluated.Results: With regard to overall response rate (ORR) and minimal response rate (MRR), there was no statistically significant difference between the 2 groups (100 vs 86.6 %, p = 0.226, and 81.25 vs 60.0 %, p = 0.252, respectively). The median time to minimal response (MR) in the BCD group was 1.3 months, which was shorter compared with that of RCD group (3.5 months, p = 0.026). Treatment-related toxicities (grade>2) were leukopenia, neutropenia, hypohepatia and pneumonia. With a median study follow-up of 27 months, disease in 18 patients (8 vs 10) progressed while 4 patients died (all in RCD group). The estimated median progression free survival (PFS) was 43 and 35 months in groups BCD and RCD, respectively, but the overall survival (OS) rate in 25 months significantly differed between the 2 groups (100 % vs 66.1 %,p = 0.033).Conclusion: The two regimens are active, produced responses and are safe as primary therapies for patients with LPL/WM. However, the response median time was much shorter in group BCD patients, and thus might have better survival benefits.