Alkylating Agents in the Treatment of Waldenström Macroglobulinemia.

The introduction of ibrutinib has grossly changed the treatment landscape in patients with Waldenström's Macroglobulinemia. Nevertheless, chemotherapy in combination with rituximab is still a cornerstone treatment. Among chemotherapeutics, alkylating agents are most frequently used. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is a highly effective but potentially neurotoxic regimen. Dexamethasone, rituximab, and cyclophosphamide (DRC) induces long responses and has a favorable toxicity profile. Bendamustine was shown to be among the most potent chemotherapeutics in combination with rituximab. Future studies must define the role of alkylating agents, which compete with highly effective chemotherapy-free targeted therapies.