Estrategias de tratamiento en pacientes con macroglobulinemia de Waldenström

Waldenström's macroglobulinemia (WM) or Waldenström's disease is a neoplasm that represents between 1 and 2% of non-Hodgkin's lymphomas.It is defined as a lymphoplasmacytic lymphoma associated with the presence of a monoclonal immunoglobulin of the IgM subtype that most frequently affects individuals between 63 and 75 years of age (1).It manifests itself through the signs and symptoms caused both by the presence of the monoclonal protein and by the infiltration produced by the tumor.Anemia and fatigue are the most frequent findings at the time of diagnosis. However, most patients remain asymptomatic for long periods, accounting for the chronic and indolent nature of this condition. The objective of this work is to carry out a bibliographic review in order to evaluate which are the treatment strategies and to try to determine the schemes that achieve the best results. In turn, a retrospective observational analysis is carried out on a group of patients with a diagnosis of WM who have undergone treatment, in order to compare the results obtained with the available bibliography.La macroglobulinemia de Waldenström (MW) o enfermedad de Waldenström es una neoplasia que representa entre el 1 y 2% de los linfomas no Hodgkin.Se define como un linfoma linfoplasmocítico asociado a la presencia de una inmunoglobulina monoclonal del subtipo IgM que afecta con mayor frecuencia a individuos entre 63 y 75 años(1). Se manifiesta a través de los signos y síntomas causados tanto por la presencia de la proteína monoclonal como por la infiltración producida por el tumor. Anemia y fatiga son los hallazgos más frecuentes al momento del diagnóstico. No obstante, la mayor parte de los pacientes permanecen asintomáticos durante largos períodos, dando cuenta del carácter crónico e indolente de esta afección.El objetivo de este trabajo es realizar una revisión bibliográfica con el fin de evaluar cuáles son las estrategias de tratamiento, para intentar determinar los esquemas que logren los mejores resultados. A su vez se realiza un análisis retrospectivo observacional de un grupo de pacientes con diagnóstico de MW que han realizado tratamiento, con el fin de comparar los resultados obtenidos con la bibliografía disponible

Retrospective Multicenter Real-Life Study on the First-Line Treatment of Classical Hodgkin Lymphoma in Argentina

Abstract There are no data in Argentina on the response rates to first-line treatment of classical Hodgkin Lymphoma (cHL) outside clinical trials. A total of 498 patients from 7 public and private hospitals in Argentina were retrospectively examined. The median follow-up was 37.4 months (CI 95% 17.7–63.5). The median time from diagnosis to treatment was 22 days (IQR 14–42), which was significantly longer in public hospitals (49.3 (IC 95% 38.5–60.2) versus 32.5 (IC 95% 27–38); p = 0.0027). A total of 96.8% of patients were treated with ABVD.:84.3% achieved complete remission (CR) and 6.02% partial remission (PR), being the CR rate higher in private hospitals. End-of-treatment metabolic CR was achieved in 85.4% (n = 373). The interim PET scan was widely used in our cohort (70.5%; n = 351), but in only 23.3% (n = 116) was the treatment strategy response-adapted. The 5-year progression-free survival (PFS) was 76% (CI 95% 70–81). The 2 and 5-years-OS rates were 91% (CI 95% 88–94%) and 85% (CI 95% 80–89%), respectively. No differences in OS were found between public and private institutions (p = 0.27). This is one of the largest retrospective cHL cohorts reported. In Argentina ABVD is the chemotherapy regimen of choice and, although it is well tolerated, it is not exempt from toxicity. We showed that early initiation of treatment impacts the induction results. Although the use of PET scan is widespread, only a minority of patients was treated with respons- adapted strategies. The use of PET-guided treatment is strongly encouraged