IWWM-12 2024 | Great debates in WM: standard front-line treatment, continuous versus fixed-duration BTKis, & more

The standard first line is not easy, but it was a nice discussion. It was Dr Buske who talked about BR, bendamastine rituximab, and Dr Kastritis about DRC, dexamethasone rituximab cyclophosphamide. We also had Dr Tedeschi and she was talking about the BTK inhibitors. The conclusion was that it was the patient who was the one who should decide because it’s so different from patient to patient what they want and what their co-mobordity is and so on. So still we have three options and that was good for that. The continuous BTKi and the more restricted treatment was discussed by Dr Berinstein from Canada and Dr Kapoor from the Mayo Clinic. Some wanted to have it until progression and some wanted to have it short but it came to the conclusion after that then we have more drugs to combine. Of course you should combine it with BTK inhibitor to get a shorter treatment because most patients like to have a shorter treatment especially if you are an older patient. This was for second-line treatment now for patients with Waldenstrom’s and there are some new drugs pirtobrutinib and this was Lia Palomba from New York who discussed that and then we had Dr Castillo who talked about venetoclax. And of course there were more data for pirtobrutinib because there had been some problems with venetoclax, especially as you had it as a combination. So still the second line treatment is much dependent on your first line and they didn’t discuss that so much. But we had no chance to give any questions because there were seven minutes then it was stop. But still, there are two really options for these patients. TP53 has been discussed in so many diseases, for example, the CLL field. You always use the mutation or the deletion. You look in every patient because you have to give different treatments for that. And in this discussion, Dr D’Sa had some very funny thing because she went to the Chat GPT to get some answers, but she didn’t get any answers. But still, she was still a bit negative because P53 mutation is not used in the general guidelines. Also, you know, in this session Dr Ramón García, someone, he thought that P53 mutation, that should be done, always, before starting treatment.