Full Answer
What is targeted therapy for Waldenstrom macroglobulinemia?
Targeted therapy for Waldenstrom macroglobulinemia includes monoclonal antibodies. A monoclonal antibody is a type of targeted therapy. It is directed against a specific protein in the cancer cells, and it does not affect cells that do not have that protein.
What kind of doctors treat Waldenstrom macroglobulinemia?
Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others. Descriptions of the common types of treatments used for Waldenstrom macroglobulinemia are listed below.
When should I seek a second opinion for Waldenstrom macroglobulinemia?
If time permits, it is often a good idea to seek a second opinion, particularly for a rare condition such as Waldenstrom macroglobulinemia. A second opinion may give you more information and help you feel more confident about the treatment plan you choose.
What is Waldenstrom’s disease (WM)?
Also known as Waldenstrom’s disease, WM is considered a type of lymphoplasmacytic lymphoma, or slow-growing non-Hodgkin’s lymphoma. Every year, around 1,000 to 1,500 people in the United States receive diagnoses with WM, according to the American Cancer Society.
What is new in the treatment of Waldenstrom macroglobulinemia?
Bortezomib, dexamethasone, and rituximab recently have been shown to be an active combination to treat Waldenstrom macroglobulinemia.
Can Waldenstrom macroglobulinemia go into remission?
Can Waldenstrom macroglobulinemia go into remission? There's a small chance that WM can go into remission, but it's not typical. Doctors have only seen complete remission of the disease in a few people. Current treatments do not prevent relapse.
How do you stage Waldenstrom's macroglobulinemia?
Doctors also use a cancer's stage when talking about survival statistics. There is no standard staging system for Waldenstrom macroglobulinemia (WM) based on the extent of the disease in the body because this hasn't been shown to be important when looking at outcomes or deciding on treatment.
How quickly does Waldenstrom's progress?
The cumulative probability of progression to symptomatic WM, amyloidosis, or lymphoma was 6% at 1 year, 39% at 3 years, 59% at 5 years, and 68% at 10 years. The major risk factors for progression were percentage of lymphoplasmacytic cells in the bone marrow, size of the serum M-spike, and the hemoglobin value.
How long can you live with WM?
The International Waldenstrom's Macroglobulinemia Foundation has found that improved treatments have put median survival rates between 14 and 16 years. Median survival is defined as the length of time at which 50 percent of people with the disease have died while the rest are still living.
Can Waldenstrom be misdiagnosed?
Waldenström's can be mistaken for multiple myeloma or indolent lymphoma, both of which are also B-cell malignancies. About 5 to 10 percent of patients who come to our center have been misdiagnosed. The most accurate way to diagnose Waldenström's is by a bone marrow biopsy.
Is Waldenstroms curable?
Waldenstrom macroglobulinemia (WM) is generally not considered to be curable, but it is treatable. Many different medicines can help keep WM under control, often for long periods of time. Not everyone with WM needs treatment right away.
Is Waldenstrom a form of leukemia?
Waldenstrom macroglobulinemia is considered a type of non-Hodgkin's lymphoma. It's sometimes called lymphoplasmacytic lymphoma.
Can Waldenstrom's turn into multiple myeloma?
Certain changes in the DNA inside normal lymphocytes can cause them to become lymphoma or multiple myeloma cells. Changes in the DNA of some lymphoma cells can also cause them to produce high levels of IgM, leading to symptoms of Waldenstrom's.
Does Waldenstroms cause fatigue?
The most common signs and symptoms to first appear in people with Waldenström macroglobulinemia are weakness and extreme tiredness (fatigue) caused by a shortage of red blood cells (anemia). Affected individuals can also experience general symptoms such as fever, night sweats, and weight loss.
How high is IgM in Waldenstrom's?
Clinical featuresPatient characteristicsMedianNormal reference rangeIgM (mg/dL)2,62040-230IgG (mg/dL)674700-1600IgA (mg/dL)5870-400Serum viscosity (cp)2.01.4-1.910 more rows
Is Waldenstrom's painful?
Neuropathy: In some people with WM, the abnormal antibody can attack and damage nerves outside the brain. This can lead to numbness or a painful “pins and needles” sensation in the feet and legs, which is called neuropathy.
Who treats Waldenstrom macroglobulinemia?
Based on your treatment options, you might have different types of doctors on your treatment team:
What are the two ways to treat WM?
The 2 main ways to treat WM are chemotherapy and different types of biological therapy (immunotherapy). One or both of these types of treatments might be used. In recent years, much progress has been made in treating people with WM.
Why do we do clinical trials?
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures . Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they're not right for everyone.
Why is it important to discuss all treatment options with your doctor?
It’s important to discuss all treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. You may feel that you need to make a decision quickly, but it’s important to give yourself time to absorb the information you have learned.
What are the different types of services that are needed for a patient?
These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
How to learn more about clinical trials?
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
Is treatment information given here official policy of the American Cancer Society?
The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.
What is the treatment for Waldenstrom macroglobulinemia?
Targeted therapy for Waldenstrom macroglobulinemia includes monoclonal antibodies. A monoclonal antibody is a type of targeted therapy. It is directed against a specific protein in the cancer cells, and it does not affect cells that do not have that protein. Rituximab (Rituxan) is a monoclonal antibody used to treat many different types of B-cell lymphoma.
How to give systemic therapy?
Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).
How does rituximab work?
Rituximab works by targeting a molecule on the surface of cells called CD20. When the antibody attaches to CD20, some lymphoma cells die and others appear to become more susceptible to chemotherapy. Rituximab can be used either alone or in combination with chemotherapy for people with Waldenstrom macroglobulinemia.
What is included in a cancer care plan?
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health.
Why do doctors want to do clinical trials?
Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer.
Can you transplant Waldenstrom?
Transplantation is only used in certain cases of Waldenstrom macroglobulinemia, because most patients are older, the treatment does not work equally well for each patient, and there are serious risks with this treatment. Side effects depend on the type of transplant, your general health, and other factors.
What is the best treatment for WM?
Some of the drugs and combinations that might be used as the first treatment for WM include: 1 Ibrutinib, with or without rituximab 2 Bendamustine, with or without rituximab 3 Bortezomib, with or without dexamethasone and/or rituximab 4 Chlorambucil 5 Cladribine, with or without rituximab 6 Cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (CHOP-R) 7 Cyclophosphamide, prednisone, and rituximab (CPR) 8 Fludarabine, with or without rituximab 9 Fludarabine, cyclophosphamide, and rituximab (FCR) 10 Rituximab 11 Rituximab, cyclophosphamide, and dexamethasone (RCD) 12 Thalidomide, with or without rituximab
How long does it take for WM to go down?
In most people with WM, the disease will respond to treatment (IgM levels will go down and symptoms will get better) within a few months, although this may take longer in people getting only rituximab . If the WM responds, options include close monitoring for signs of disease progression or giving rituximab on a regular schedule to help keep the disease in check.
Can you take WM with chemotherapy?
Some doctors like to combine drugs (often some type of chemotherapy plus rituximab), while others prefer to start with a single drug. The patient’s age, overall health, and symptoms can also affect which treatments are recommended.
Can WM be treated?
Many different medicines can help keep WM under control, often for long periods of time. Not everyone with WM needs treatment right away. In fact, some people are diagnosed with WM before they even have symptoms from it. Most experts recommend that people with WM should not usually be treated until the disease is causing problems.
Can WM turn into lymphoma?
Sometimes WM can turn into an aggressive lymphoma. When this happens, the cancer grows much more quickly and causes symptoms that can soon become life threatening. These lymphomas are usually treated with a combination of several chemo drugs like those used for patients who are first diagnosed with an aggressive non-Hodgkin lymphoma (see Treating Non-Hodgkin Lymphoma ). If combination chemo is not successful, high-dose chemo with a stem cell transplant may be an option.
What is the treatment for WM?
The treatment of WM has evolved rapidly, with treatment options that include anti-CD20 monoclonal antibody-based combinations and BTK inhibitors. The choice of therapy is based on the need for rapid disease control, presence of specific disease complications, and patient’s age.
What is Waldenström macroglobulinemia?
Waldenström macroglobulinemia (WM) is an uncommon lymphoma characterized by the infiltration of the bone marrow by clonal lymphoplasmacytic cells that produce monoclonal immunoglobulin M (IgM).
How long does WM last?
The level of monoclonal IgM alone is not an indication to start treatment 31,32 ; however, among those with high IgM levels (>6000 mg/dL), data are conflicting. 33,34 Our approach is to follow such patients closely. Recently, a score based on BM infiltration percentage, IgM levels, b2-microglobulin, and albumin was developed that identified 3 groups of asymptomatic WM with a median time to development of symptomatic disease of 1.8, 4.8, and 9.3 years. 7 There are no data to support early initiation of therapy over a watch-and-wait strategy, even in patients at high risk for progression; such patients should be managed in clinical trials. The patient in case 1 was asymptomatic at initial evaluation and, according to the score above, at intermediate risk. A close follow-up and clinical evaluation is important, and he was followed clinically at 3-month intervals, at least for the first couple of years, to evaluate the pace of the disease.
What are the complications of WM?
Most patients with WM will have a prolonged disease course with multiple lines of therapy , and may struggle with various complications. Patients with WM are at risk for infections; hypogammaglobulinemia is common and persists despite response to treatment, but is not associated with the incidence of recurrent infections. 19 Vaccinations are recommended; use of intravenous immunoglobulin is not recommended unless frequent severe infections occur. Second primary malignancies (solid tumors, skin cancers, and myelodysplasia), as well as transformation to aggressive lymphomas, can occur. A significant proportion of previously untreated patients with WM already harbor evidence of clonal hematopoiesis of indeterminate potential. 97 Physicians should educate their patients to adhere to standard screening for solid tumors, and appropriately evaluate anemia or cytopenias not related to disease progression.
When did Kyle et al confirm the indications for therapy?
Indications to start therapy are according to consensus criteria first published by Kyle et al 31 and further confirmed in 2019 98 and in 2016. 32
Is there a threshold for BM infiltration by clonal cells to define WM?
8 Per Consensus criteria 5 and World Health Organization definitions, 6 there is no threshold for the BM infiltration by clonal cells to define WM. 5 Individuals with less than 10% clonal cells have an indolent course 7 similar to that of MGUS compared with those with at least 10% LPL infiltration who have a higher risk for progression to symptomatic WM. 8 However, patients not fulfilling WM criteria may still need treatment of the management of IgM-related complications.
Is Waldenstrom's macroglobulinemia a hypoferremic disease?
Patients with Waldenstrom’s macroglobulinemia are often hypoferremic that is refractory to oral iron repletion and responsive to parental iron infusions, and demonstrate elevated levels of hepcidin [abstract]
How long after Waldenstrom macroglobulinemia treatment?
Typically, follow-up visits are most frequent in the first 3 years after treatment for Waldenstrom macroglobulinemia. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling.
How to keep track of cancer treatment?
Keeping personal health records. You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. ...
Why do we need follow up care?
One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar ...
How long does cancer treatment last?
Almost any cancer treatment can have side effects. Some last for a few weeks to several months, but others can be permanent. Don’t hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.
Is Waldenstrom macroglobulinemia a cure?
Current treatments for Waldenstrom macroglobulinemia (WM) are not likely to result in a cure. Most people with WM are treated for some time, followed by a break, and then treated again when the disease comes back. Learning to live with cancer that does not go away can be difficult and very stressful.
Can I lower my risk of Waldenstrom Macroglobulinemia progressing or coming back?
If you have (or have had) WM, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements.
What is the drug used to treat WM?
Ibrutinib(Imbruvica®) blocks a protein called Bruton tyrosine kinase (BTK) insidelymphoma cells, which normally helps the cells grow and survive. This drug can be usedalone to treat WM, or in combination with rituximab . Ibrutinib is taken by mouth, once aday. Common side effects include diarrhea or constipation, nausea and vomiting,fatigue, swelling, decreased appetite, and low blood counts.
How do immunomodulating drugs work?
Immunomodulating drugs (IMiDs) are thought to work against certain cancers byboosting parts of your immune system, although exactly how they work is not clear.These drugs are most often used to treat multiple myeloma2, but they might also behelpful in treating WM.
Can WM cells be removed from blood?
Most transplants in people with WM are autologous. The patient’s own blood-formingstem cells are removed from their bloodstream and stored to use later. Then the patientis given high doses of chemo (and sometimes radiation) to kill the WM cells. The highdoses of chemo kill the normal bone marrow cells as well as the cancer cells. Afterchemo, the frozen stem cells are thawed and returned to the body (like a bloodtransfusion).
What kind of doctor treats Waldenstrom?
At Mayo Clinic, a multidisciplinary team of experts provides whole-person care to those with Waldenstrom macroglobulinemia. Your care team may include hematologists, pathologists, radiologists, nephrologists and neurologists. Other experts are included as needed.
Can Waldenstrom macroglobulinemia be cured?
At Mayo Clinic, a multidisciplinary team of experts works together with you to understand your condition and create a treatment plan that meets your needs and goals. Though this rare disease can't be cured, Waldenstrom macroglobulinemia can be controlled. Mayo Clinic doctors draw on their extensive experience to provide you with expert, personalized care.
Does Mayo Clinic treat Waldenstrom?
People who seek care at Mayo Clinic have access to all the available treatment options for Waldenstrom macroglobulinemia, including autologous stem cell transplant and clinical trials. Your care team will work closely with you to understand your needs and goals and to develop a personalized treatment plan.