The UK charity for Waldenstrom’s macroglobulinaemia – a rare type of blood cancer

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Common Treatment
Regimens for WM

For people with Waldenstrom’s macroglobulinaemia, the most common first-line treatments are combinations of drugs. These combinations are known as ‘regimens’.

Regimens are usually split into cycles. You’ll have the drugs at one point in the cycle, before having a period of not taking them. Because treatment can have side effects or be harsh on your body, cycles give your body time to recover. Cycles vary in length depending on what drugs you are taking, but usually last around 2-6 weeks. You’ll normally have multiple cycles as part of your treatment.

Treatment regimens
used for WM

There are two regimens most commonly used to treat Waldenstrom’s macroglobulinaemia: BR and DRC. Both these regimens have shown to effectively reduce the amount of cells that cause WM, helping people living with WM to go into remission and feel better. They’re also safe regimens to have had if you are offered a stem cell transplant later on.

Both these regimens are recommended as first-line treatment for WM patients.

bendamustine & rituximab

BR is a combination of two drugs: bendamustine and rituximab often used to treat Waldenstrom’s macroglobulinaemia (WM). Bendamustine is a type of chemotherapy and rituximab is a monoclonal antibody.

You receive bendamustine through a small tube into your vein (intravenously). You normally receive bendamustine on days 1 and 2 of each cycle.

You also receive rituximab intravenously, and this is usually given on day 1 of each cycle. Sometimes your dose of rituximab will be delayed if you blood test results show that you have high levels of IgM. This is because rituximab can cause IgM to increase (called an IgM flare).

You will usually have 4-6 cycles of BR.

DRC

Dexamethasone, rituximab & cyclophosphamide

DRC is a combination of three drugs: dexamethasone, rituximab and cyclophosphamide. Dexamethasone is a steroid that can help reduce some of the side effects of chemotherapy, rituximab is a monoclonal antibody and cyclophosphamide is a type of chemotherapy drug.

You usually receive dexamethasone and rituximab intravenously on day 1 of each cycle. Cyclophosphamide is taken as a tablet, and you’ll normally take two tablets for the first five days of your cycle.

In total, you’ll usually have 6 cycles of DRC, each cycle lasting 21 days.

Is one regimen better than the other?

The type of treatment you’re offered will be down to your individual circumstances, including your general health and symptoms of WM.

There aren’t any trials that have directly compared BR and DRC. Researchers have looked at other data about the regimens and found evidence to suggest that BR may be more effective in the long term, meaning that your Waldenstrom’s macroglobulinaemia could take longer to come back. In the study, people who receive BR and DRC had similar responses, meaning both regimens were effective in killing the cells responsible for WM.

BR is a more toxic treatment, meaning that can be harsh on the body and isn’t suitable for everyone. Sometimes the dose might need to be reduced or you may not have as many cycles as your doctor planned because of the treatment’s toxicity.

DRC is less toxic, and studies have shown that fewer people get serious side effects that affect their treatment and quality of life.