Treatment for Waldenström macroglobulinemia (WM) differs from treatment for other types of lymphoma and must be tailored to each individual. It’s important to be treated at a specialized center with expertise in WM. But because the condition is rare, many hospitals and clinics do not have much experience with it.
Seattle Cancer Care Alliance (SCCA) experts offer comprehensive Waldenström macroglobulinemia treatment.
A diagnosis of WM can feel overwhelming. We have an experienced, compassionate team ready to help.
- Expertise at SCCA
- Watchful waiting
- Plasma exchange
- Targeted therapy
- Bone marrow transplant
- Clinical studies
- Next steps
Waldenström macroglobulinemia expertise at SCCA
Everything you need is here
WM is treatable and may be controlled for a long time with expert care. We have medical oncologists and hematologists who specialize in WM; the most advanced diagnostic, treatment and recovery programs; and support for you throughout your treatment and beyond. Our doctors are internationally known for their contributions to knowledge about this condition.
Innovative WM therapies
SCCA is involved in research to better understand WM and to identify more effective treatments, such as medicines that target WM cells in new ways. We collaborate with experts at other research and treatment centers to improve care for everyone living with WM.
WM treatment tailored to you
Few studies have compared the medicines used for WM, so there’s no single standard treatment. Your SCCA doctor will explain your options and recommend an individualized treatment plan based on the specifics of your disease as well as your overall health, personal preferences and other factors.
Your personal team includes an oncologist, nurse case manager and team coordinator. Additional experts who specialize in treating people with cancer will be involved if you need them — experts like a palliative care professional, social worker, physical therapist or dietitian.
Ongoing care and support
Throughout treatment, your team provides follow-up care on a schedule tailored to you. The SCCA Survivorship Clinic is also here to help you live your healthiest life. Each year we host an educational and support meeting for people with WM sponsored by the International Waldenström Macroglobulinemia Foundation.
Watchful waiting for Waldenström macroglobulinemia
If you are otherwise healthy and WM isn’t causing you symptoms or health problems (or they don’t bother you and aren’t serious), you may not need any treatment for months or years.
Instead, your doctor may recommend watchful waiting. This means seeing your doctor for exams and tests on a regular schedule or if anything about your condition changes.
Watchful waiting can be a valuable option for protecting your health while also preserving your quality of life and avoiding unnecessary treatments as well as the side effects sometimes associated with treatment.
It’s important to talk with your WM team about your specific situation, including how to decide when it is time to begin treatment and which treatment option, or combination of options, may be best for you then.
Plasma exchange for Waldenström macroglobulinemia
If you have a high level of IgM in your blood that has made your blood thicker than normal and is causing symptoms (hyperviscosity syndrome), you may need plasma exchange (plasmapheresis). It can reduce the thickness of your blood and help relieve your symptoms.
At SCCA, we perform plasmapheresis every day, and we make it easy for you to receive this treatment when you need it.
- Two intravenous (IV) lines are inserted in your arms or in a central venous catheter near your collarbone.
- Your blood is removed through one line, it passes through a machine, and it is returned to your body through the other line.
- The machine separates the liquid part of your blood (plasma), which contains the IgM, from your white and red blood cells.
- Your blood cells are mixed with a plasma substitute (made from donated plasma and a salt solution) before being returned to your body.
Chemotherapy for Waldenström macroglobulinemia
Chemotherapy is one of the main treatments for WM. Your doctors may recommend chemo alone or in combination with targeted therapy or immunotherapy.
Chemotherapy is given through an IV line, as an injection just under your skin (subcutaneously) or by mouth in repeating cycles every few weeks.
Typical chemotherapy medicines for WM include:
- Bendmustine (Treanda)
- Corticosteroids (prednisone, dexamethasone)
- Cyclophosphamide (Cytoxan)
- Bortezomib (Velcade)
- Carfilzomib (Kyprolis)
Your SCCA team will talk with you about the specific medicines we recommend for you, how you’ll receive them, your treatment schedule and what to expect. We’ll also explain how to take the best possible care of yourself during treatment and after, and connect you with medical and support resources throughout SCCA.
Targeted therapy for Waldenström macroglobulinemia
Along with chemotherapy, targeted therapy is another important treatment for WM.
Targeted therapies are newer treatments that work more selectively than standard chemo. They target a gene or protein responsible for allowing abnormal cells to grow, they seek out and damage abnormal cells, or they prompt your immune system to attack particular cells or substances (also called immunotherapy).
Several targeted therapies are used for WM or are being studied in clinical trials looking for better treatments. They include:
- Monoclonal antibodies — antibodies made in a lab that attach to specific proteins on WM cells. They include rituximab (Rituxan), obinutuzumab (Gazyva) and ofatumumab (Arzerra).
- BTK inhibitors — which target a molecular pathway in the WM cell that causes the disease. Ibrutinib (Imbruvica) is a BTK inhibitor used for WM and some other types of lymphoma and leukemia.
- Proteasome inhibitors — which target enzymes and interfere with the growth of your disease-causing cells. Bortezomib and carfilzomib are examples.
Immunotherapy for Waldenström macroglobulinemia
Immunotherapies are treatments that harness your immune system to fight your cancer. Monoclonal antibodies are considered both targeted therapies and immunotherapies.
Rarely, doctors use immunomodulatory medicines, like lenalidomide (Revlimid) and pomalidomide (Pomalyst), which change the way your immune system responds. These aren’t used often because of complications that can occur.
Bone marrow transplant for Waldenström macroglobulinemia
Though bone marrow transplant is not used often for WM, it may be the right option for some people. Usually, this means a transplant using your own cells (autologous transplant).
- First, your stem cells are removed and purged of disease-causing cells.
- Next, you receive strong chemotherapy to eliminate the disease-causing cells still in your body.
- Then, your stem cells are infused back into your bloodstream to restart your body’s ability to form blood cells.
Less often, doctors transplant stem cells from a donor (allogeneic transplant). More people are eligible for allogeneic transplants than ever before, due to advances available at SCCA, such as nonmyeloablative (reduced-intensity) transplants, which use lower-dose chemotherapy.
We have experts in transplant for people with WM. Learn more about the Fred Hutch Bone Marrow Transplant Program at SCCA, including the lifelong support you get through our Long-Term Follow-Up Program for transplant recipients.
Clinical studies for Waldenström macroglobulinemia
For some people, taking part in a clinical study may be the best treatment choice. Access to clinical studies by researchers at SCCA and our founding organizations Fred Hutch and UW Medicine is one reason many patients come to SCCA.
We have participated in and contributed to many studies testing new medicines with unique ways to suppress or kill WM cells.