Bortezomib, Dexamethasone, and Rituximab in Untreated Waldenstroms Macroglobulinemia (BDR-WM)

Inclusion Criteria:

Each patient must meet all of the following inclusion criteria to be enrolled in this study:

• Clinicopathological diagnosis of Waldenstroms macroglobulinemia as defined by consensus panel one of the Second International Workshop on Waldenstroms macroglobulinemia.
• All patients with the diagnosis of WM will be evaluable for response according to the response criteria
• No prior systemic treatment for WM. Prior plasmapheresis to control hyperviscosity, is allowed. In that case baseline monoclonal protein levels for assessment of response will be the levels prior to plasmapheresis, if this is the higher value prior to treatment initiation
• Patients must have at least one of the following indications to initiate treatment as defined by Consensus Panel Two recommendations from the Second -
• International Workshop on Waldenstroms Macroglobulinemia.
• Recurrent fever, night sweats, weight loss, fatigue
• Hyperviscosity
• Lymphadenopathy which is either symptomatic or bulky (>5cm in maximum diameter)
• Symptomatic hepatomegaly and/or splenomegaly
• Symptomatic organomegaly and/or organ or tissue infiltration
• Peripheral neuropathy due to WM
• Symptomatic cryoglobulinemia
• Cold agglutinin anemia
• Immune hemolytic anemia and/or thrombocytopenia
• Nephropathy related to WM
• Amyloidosis related to WM
• Hemoglobin < 10g/dL
• Platelet count < 100x109/L
• Serum monoclonal protein >5g/dL even with no symptoms
• CD20 positive disease based on any previous bone marrow immunohistochemistry or flow cytometric analysis performed up to 3 months prior to enrollment.
• Karnofsky performance status more than 60.
• Life-expectancy >3 months.
• Baseline platelet count more than 50x109/L, and absolute neutrophil count more than 0.75x109/L.

• Meet the following pretreatment laboratory criteria at the Screening visit conducted within 28 days of study enrollment:

  • AST (SGOT): less than 3 times the upper limit of institutional laboratory normal.
  • ALT (SGPT): less than 3 times the upper limit of institutional laboratory normal.
• Total Bilirubin: less than 2 times the upper limit of institutional laboratory normal, unless clearly related to the disease.
• Calculated or measured creatinine clearance: less than 30 mL/minute. Serum sodium >130 mmol/L.
• Voluntary written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.

Exclusion Criteria:

• Patients meeting any of the following exclusion criteria are not to be enrolled in the study.
• Prior systemic treatment with WM (plasmapheresis is allowed)
• Myocardial infarction within 6 months prior to enrollment or has New York
• Hospital Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Prior to study entry, any ECG abnormality at Screening has to be documented by the investigator as not medically relevant.
• Patient has hypersensitivity to dexamethasone, bortezomib, boron or mannitol.
• Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
• Cardiac amyloidosis
• Peripheral neuropathy or neuropathic pain grade 2 or higher as defined by NCI - CTCAE version 3
• Women who are pregnant.
• Women who are breast-feeding and do not consent to discontinue breast-feeding.
• Women of childbearing age who are not willing to use effective anti-conceptive methods for the duration of the study and 6 months thereafter.
• Men who do not consent not to father a child during the treatment period and six months thereafter.