Waldenstrom’s macroglobulinemia

What is Waldenstrom’s macroglobulinemia ?

Waldenstrom’s macroglobulinemia(WM) is a cancerous disorder of the b-cells of the lymphatic system and bone marrow. These cells are called “lymphoplasmacytic” by pathologists who look at the cells under the microscope. The disease is also referred to as lymphoplasmacytic lymphoma (LPL).

In WM, the abnormal b-cells secrete a unique immunoglobulin (IgM) that can be easily measured in the blood. WM cells reside in the bone marrow and spleen. The exact cause of WM is unknown, however, a minority of patients have a family history of WM (20 percent).

Although it is true that there is no cure, the disease is highly treatable. With the newer therapies now available for patients, the average lifespan of patients with WM is steadily increasing.

Symptoms and diagnosis

Patients may be asymptomatic when they are diagnosed with WM. For those who are symptomatic, weakness, loss of appetite, weight loss, and fatigue are common. Some patients have neuropathy. The liver and/or spleen may be enlarged as well as lymph nodes. Less common manifestations include mental status changes, nasal bleeding, blurred vision, and bruising. Diagnosis of WM is often suspected by finding anemia and abnormal proteins (IgM) in the blood. X-rays may be abnormal. Definitive diagnosis requires a bone marrow biopsy.

Treatment of WM

There is no “standard” treatment for WM. Fortunately research in this disease is moving ahead and new pathways for therapy are being discovered.

Therapy for newly diagnosed patients may include alkylators (eg, chlorambucil and cyclophosphamide), nucleoside analogs (cladribine or fludarabine), and rituximab. In certain circumstances WM patients may require plasma exchange therapy early in the disease course.

Newer treatments that are under study and which have shown promise include the proteosome inhibitors (bortezomib) and bendamustine. In some cases, autologous and or allogeneic stem cell transplantation is used.

Seattle Cancer Care Alliance has experience in treating WM with standard chemotherapy and with stem cell transplantation. Most experts recommend that patients with WM be considered for clinical trials whenever possible because there is so much still to be learned about this disease.

Research studies may be available for patients with WM at Seattle Cancer Care Alliance.

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