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Knowledge Gaps Revealed in Waldenström Macroglobulinemia

Waldenström macroglobulinemia is a rare lymphoproliferative disorder, with an estimated 1,500 new cases reported in the United States each year. This malignancy, which accounts for 2% of non-Hodgkin lymphomas, is characterized by lymphoplasmacytic bone marrow infiltration and the presence of serum monoclonal immunoglobulin M (IgM). It is important for health care professionals involved in the care of patients with Waldenström macroglobulinemia to remain up to date in their knowledge of risk stratification systems, efficacy and safety data for novel therapeutic approaches, and surveillance and management strategies for adverse events associated with novel treatments.

Baseline data collected from i3 Health's continuing medical education (CME)/nursing continuing professional development (NCPD)–approved visiting faculty meeting series titled Improving Treatment Outcomes of Patients With Waldenström Macroglobulinemia, led by Morie A. Gertz, MD, MACP, Professor of Medicine at Mayo Clinic in Rochester, MN, and Toni Dubeau, RN, NP, Nurse Practitioner at Dana-Farber Cancer Institute in Boston, MA, confirmed that knowledge gaps exist surrounding the assessment and treatment of patients with Waldenström macroglobulinemia.

All of the 511 learners who took the pretest and began the activity, which was available online from May 10, 2019, to May 9, 2020, saw it through to completion. The learners were primarily registered nurses (93.5%), followed by nurse practitioners (3.5%), physicians (1.4%), individuals who selected "other" for their profession (1.4%), and one physician assistant (0.2%). More than 70% of participants had been in practice for over 11 years, and participants saw an average of 2.4 patients with Waldenström macroglobulinemia per month. Learners were given a pretest prior to beginning the activity and a posttest consisting of the same questions following the activity's conclusion.

The baseline assessment showed significant knowledge gaps. Few learners (6%) correctly identified the likelihood that a patient with rituximab-refractory Waldenström macroglobulinemia would respond to ibrutinib therapy. Only 16% of learners identified 35 months as the expected median progression-free survival after treatment with dexamethasone/rituximab/cyclophosphamide for a patient presenting with previously untreated, symptomatic Waldenström macroglobulinemia. Slightly more learners (18%) correctly stratified a patient presenting with more than two adverse characteristics to be high risk according to the International Prognostic Scoring System (IPSS) for Waldenström macroglobulinemia. More learners were familiar with the effects of ibrutinib treatment for Waldenström macroglobulinemia, with 35% of learners correctly identifying diarrhea as the most likely adverse event associated with this therapy, and 63% of learners knowing that electrocardiogram monitoring is recommended for patients treated with ibrutinib.

Significant learning took place during the activity with respect to all topics according to the post-activity assessment: 92% of learners correctly identified that the likelihood of response to ibrutinib therapy for a patient with rituximab-refractory Waldenström macroglobulinemia was 90.5%; 93% correctly identified the expected median progression-free survival of a patient with untreated, symptomatic Waldenström macroglobulinemia after primary therapy; 93% correctly assessed the risk of a patient according to the IPSS for Waldenström macroglobulinemia; 97% correctly identified the most likely adverse event associated with ibrutinib; and 94% knew to recommend electrocardiogram monitoring for patients treated with ibrutinib, since treatment with ibrutinib is associated with a higher incidence of atrial fibrillation.

Learners' performance on the pre- and post-activity assessment suggested that their competence improved regarding Waldenström macroglobulinemia risk assessment, efficacy and safety of novel first- and second-line therapies, and strategies to monitor treatment-related adverse events. i3 Health has determined that the multidisciplinary team may benefit from future CME/NCPD–approved activities that provide further and updated Waldenström macroglobulinemia education.

Upon completion of the activity, 90% of participants felt more confident in treating their patients with Waldenström macroglobulinemia, and 90% felt that the material presented would be used to improve the outcomes of their patients.

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