A study looking at bortezomib for Waldenstrom's macroglobulinaemia (UK R2W)

Please note - this trial is no longer recruiting patients. We hope to add results when they are available.

Cancer type:

Blood cancers
Low grade lymphoma
Non-Hodgkin lymphoma




Phase 2

This study is looking at adding bortezomib (Velcade) to cyclophosphamide and rituximab (Mabthera) for Waldenstrom’s macroglobulinaemia (pronounced wall-den-stroms mak-row-glob-you-lin-ee-mee-a). This is a rare and slow growing type of non Hodgkin lymphoma (NHL). It is also sometimes called lymphoplasmacytic NHL (pronounced lim-fo-plaz-ma-sit-ik). This study is supported by Cancer Research UK.

Doctors can treat Waldenstrom’s macroglobulinaemia with a combination of drugs called fludarabine, cyclophosphamide and rituximab (FCR). This combination can work, but doctors are always looking to improve treatment.

Bortezomib is a type of biological therapy. It is a cancer growth blocker. It stops signals that cancer cells use to divide and grow.

We know from research that bortezomib helps people whose Waldenstrom’s macroglobulinaemia has come after treatment or continued to grow during treatment. We also know that having bortezomib with rituximab may be better.

In this trial the researchers want to combine bortezomib with cyclophosphamide and rituximab (BCR) to see if it can help people with Waldenstrom’s macroglobulinaemia. They also want to compare BCR with FCR.

The aims of this trial are to find out

  • How well BCR works for people with Waldenstrom’s macroglobulinaemia
  • How safe BCR is
  • What the side effects are
  • If BCR should be studied further

Who can enter

You may be able to enter this trial if you

  • Have Waldenstrom’s macroglobulinaemia that your doctor feels needs to be treated
  • Have a protein, called IgM, in your blood and it can be measured -  your doctor can confirm this
  • Are well enough to be up and about for at least half the day (performance status 0, 1 or 2)
  • Are willing to use reliable contraception during treatment and for at least a year afterwards if there is a chance you or our partner could become pregnant
  • Are at least 18 years old

You cannot enter this trial if

  • You have already had treatment for your Waldenstrom’s macroglobulinaemia
  • You have low levels of blood cells and that is caused by a disease where the body mistakes something that is natural to it as foreign (an autoimmune disease Open a glossary item)
  • You have moderate to severe nerve damage
  • Your kidneys aren’t working
  • You have severe liver damage
  • You have hepatitis B or hepatitis C and your infection is causing problems
  • You are HIV positive
  • You are allergic to the chemical element boron or the drug mannitol
  • You have had another cancer in the past 5 years apart from successfully treated non melanoma skin cancer or a very early stage cancer that was successfully treated (in situ carcinoma Open a glossary item)
  • You have an infection that needs treatment
  • You have a very serious problem with your heart, lungs, nerves or any other serious medical condition
  • You are having treatment as part of another clinical trial
  • You are pregnant or breastfeeding

Trial design

This is a phase 2 trial. There are 2 stages in this trial.

In the first stage it will recruit 6 people. Everyone will have bortezomib, cyclophosphamide and rituximab. The researchers want to find out what the side effects of this combination are and how safe it is. If the side effects aren’t too bad and the researchers feel it is safe to give they will go on to the 2nd stage.

The second stage is a randomised trial. It will recruit 50 people.

You will be put into 1 of 2 treatment groups by a computer. Neither you nor your doctor can choose which group you are in.

The 2 groups are

  • Bortezomib, cyclophosphamide and rituximab (BCR)
  • Fludarabine, cyclophosphamide and rituximab (FCR)

UK R2W Study Diagram

The treatment is organised into 4 week periods, which are called cycles of treatment. When you get to the end of the first cycle, you start the second and so on. You can have up to 6 cycles.

You have rituximab as an injection into a vein. You have rituximab once every week during the 2nd and 5th cycle of treatment only.

You have bortezomib as an injection under the skin. You have it once a week for the first 3 weeks of each cycle of treatment.

Fludarabine and cyclophosphamide are tablets. If you are in the BCR group, you take the cyclophosphamide tablets once a week during the first 3 weeks of each cycle. If you are in the FCR group you take the cyclophosphamide and fludarabine tablets during the first 3 days of each cycle of treatment.

After 3 cycles of treatment (12 weeks) you have tests to see how you are responding to treatment. Depending on the results of the tests and if the side effects aren’t too bad you can have another 3 cycles of treatment.

The research team will ask you to fill in a questionnaire before starting treatment, at 3 months and after finishing treatment. It will ask you about how you have been feeling and any side effects you may have. This is called a quality of life study.

Hospital visits

You see the doctor to have some tests before taking part in this trial. These tests include

During treatment you see the doctor regularly for a physical examination, blood tests and to check for side effects.

At the end of treatment you see the doctor for blood tests and a CT scan if needed. After another 3 months, you see the doctor for blood tests and a bone marrow test. You then see the doctor every 3 months for 5 years.

Side effects

The most common side effects of fludarabine, cyclophosphamide and rituximab (FCR) are

The most common side effects of bortezomib are

Your doctor will talk to you about the possible side effects of treatment before you agree to take part in the trial.

We have more information about bortezomib, cyclophosphamide, fludarabine and rituximab in our cancer drugs section.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Rebecca Auer

Supported by

Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
NIHR Clinical Research Network: Cancer
University College London (UCL)

Other information

This is Cancer Research UK trial number CRUK/11/030.

Questions about cancer? Contact our information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

Oracle 8777

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Charlie took part in a trial to try new treatments

A picture of Charlie

“I think it’s really important that people keep signing up to these type of trials to push research forward.”

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