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27

NCCN Guidelines for Patients

®

:

Waldenström’s Macroglobulinemia, Version 1.2017

3

Cancer treatments

Targeted therapy

This drug can cause an IgM flare. The level of IgM

goes up due to large amounts being released from

dying cells. This flare will cause hyperviscosity and

the symptoms that come with it. Your doctor may

recommend plasmapheresis before you receive this

drug. This depends on whether your IgM level is very

high or a test for serum viscosity shows your blood is

very thick.

Rituximab also increases your chances for tumor

lysis syndrome. This syndrome causes problems

in the blood from cells dying and leaving waste.

Other problems include heart issues or a blockage

and holes in your gut. Serious infections, such as

progressive multifocal leukoencephalopathy, are very

rare.

If you who can’t take rituximab, your doctor can

offer ofatumumab. This drug also targets the CD20

antigen. It can briefly increase IgM in the blood. Your

doctor will continue to check your IgM level if you

receive targeted therapy.

Bortezomib

Bortezomib is another targeted therapy used to

treat WM. It is very active in the treatment of WM.

It works by a number of mechanisms, one of which

stops the proteasome in the cell. The proteasome

is the machinery needed to dispose of unwanted

proteins in the cell. Bortezomib stops the cell division

and causes cell death. It can be given alone, with

rituximab, or with rituximab and dexamethasone.

Bortezomib is a liquid that is slowly injected into a

vein for a certain period of time. It can also be given

as an injection under the skin (subcutaneous). The

doctor will decide on the amount given, how long it is

given, and how often you get this drug.

Common side effects of bortezomib are:

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Extreme tiredness (fatigue)

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Fever

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Not wanting to eat

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Nausea and vomiting

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Diarrhea

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Constipation

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Low blood cell counts

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Nerve damage (neuropathy)

This drug can cause a certain type of neuropathy

called peripheral neuropathy. This type of neuropathy

affects the hands and feet. It can begin with

sensitivity to cold, pain, burning, and numbness. If

someone already has this neuropathy, this drug can

make it worse.

Bortezomib can also reactivate the herpes zoster

virus. This virus can cause painful blisters or a rash

on the skin. Your doctor can give medication to

prevent the virus from reactivating.

Ibrutinib

Ibrutinib interferes with the BTK (

B

ruton’s

t

yrosine

k

inase). BTK is activated by mutated MYD88. People

with CXCR4 mutations show lower response rates

and delayed responses to ibrutinib. This molecule of

the B-cell helps the cell survive by sending signals.

This drug stops the signals so the cell can’t grow or

divide.

Ibrutinib is given alone. It comes in pill form and is

taken by mouth. It is usually taken once a day. Your

doctor or pharmacist can answer any questions you

have about the dose or time you should take this

drug.