Bortezomib (velcade) in combination with Rituximab have been shown to act synergistically in in vitro and in vivo models. Bortezomib plus Rituximab in combination have been used in a phase 2 clinical study for previously treated patients with indolent non-Hodgkin's lymphoma. Patients received either Bortezomib 1,3mg/m2 on d1,4,8,11 q21 days (Group A), or Bortezomib 1,6mg/m2 weekly on d1,8,15,22 q35 days (Group B). Rituximab 375mg/m2 was administered weekly for 4 weeks in all patients. Response rated were similar in groups A and B, but patients in Group B (weekly bortezomib at increased dose) experienced less toxicity. Furthermore, glucocorticoids acte synergistically with Rituximab in inducing apoptosis against various malignant NHL B cell lines. A single dose of dexamethasone administered immediately before rituximab was adequate for this synergistic effect. Furthermore, we have tested this sequence in vivo in the context of a prospective trial of dexamethasone, rituximab and cyclophosphamide for previously untreated patients with WM. This combination induced responses in 74% of patients. Based on the above we investigate a combination of bortezomib, dexamethasone and rituximab (BDR) as primary treatment for patients with WM. The following points are of importance: