Medication
If you’ve been diagnosed with Waldenstrom macroglobulinemia, your treatment team will discuss your options with you. It’s important to weigh the benefits of each treatment option against the possible risks and side effects. How is Waldenstrom macroglobulinemia treated?
Procedures
Maintenance rituximab is associated with improved clinical outcome in rituximab naive patients with Waldenstrom Macroglobulinaemia who respond to a rituximab-containing regimen. British Journal of Haematology, 154(3), 357–362. 10.1111/j.1365-2141.2011.08750.x [PubMed] [CrossRef] [Google Scholar]
Self-care
Some of the drugs and combinations that might be used as the first treatment for WM include: Ibrutinib, with or without rituximab. Bendamustine, with or without rituximab. Bortezomib, with or without dexamethasone and/or rituximab. Chlorambucil.
Nutrition
Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: An open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet, 381(9873), 1203–1210. 10.1016/S0140-6736(12)61763-2 [PubMed] [CrossRef] [Google Scholar]
What should I do if I’ve been diagnosed with Waldenstrom macroglobulinemia?
Does maintenance rituximab improve outcome in Waldenstrom macroglobulinaemia?
What is the best treatment for Wernicke-Müller syndrome?
What is the first-line treatment for indolent and mantle-cell lymphoma?
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 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 long can you live with Waldenstrom's?
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 Waldenstroms 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 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
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.
What are the end stages of Waldenstrom's?
Staging/Prognostic Scoring System for Waldenstrom Macroglobulinemia/Lymphoplasmacytic LymphomaScoreStage3-year WM-related mortality1Low10%2Intermediate14%3High38%4-5Very high48%1 more row•Dec 21, 2020
What is the success rate of rituximab?
Rituximab with bendamustine (Treanda, Cephalon) was studied in a phase 2 trial in patients with relapsed disease. This combination was found to be very effective, with an ORR of 92%.
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.
How long does it take for Rituximab to respond to Waldenstrom's?
Results: Twelve patients (44%; 95% confidence interval, 25.5% to 64.7%) achieved a partial response after treatment with rituximab. Median time to response was 3.3 months (range, 2.2 to 7.1 months).
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.
How can Waldenstrom macroglobulinemia be prevented?
Most of the risk factors for Waldenstrom macroglobulinemia (WM), such as older age or monoclonal gammopathy of undetermined significance (MGUS), can't be changed or controlled, so there is no way to prevent cancers that might be related to these risk factors.
What are the stages of Waldenstrom?
Staging/Prognostic Scoring System for Waldenstrom Macroglobulinemia/Lymphoplasmacytic LymphomaScoreStage5-year overall survival1Low86%2Intermediate78%3High47%4-5Very high36%1 more row•Dec 21, 2020
How is Lymphoplasmacytic lymphoma staged?
Most types of lymphoma are staged to find out which parts of your body are affected by lymphoma. The staging system is based on how many swollen lymph nodes you have and where they are in your body. This system is not useful for WM because the disease is often in the bone marrow rather than the lymph nodes.
What is smoldering Waldenstrom's?
Smoldering Waldenström's Macroglobulinemia (SWM) is defined as a serum IgM monoclonal protein ≥3 g/dL and/or ≥10% bone marrow lymphoplasmacytic infiltration but no evidence of constitutional symptoms, symptomatic anemia, or hyperviscosity. Forty-eight patients with SWM were identified at Mayo Clinic from 1974 to 1995.
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.
What Symptoms Indicate it is Time to Seek Treatment for Waldenstrom Macroglobulinemia?
Approximately 30% of Waldenstrom macroglobulinemia patients are advised to "watch and wait" at time of diagnosis. When should a patient seek treatment?
Criteria to End Watch and Wait and Seek Treatment
Dr. Treon: Back in 2002, when we had the second international workshop on Waldenstrom's, one of the important consensus panels dealt with this question. It was important because the way patients were being cared for with Waldenstrom's varied.
Waldenstrom Symptoms that Indicate it is time to Start Treatment
Some of the classical criteria are if the patient has a hemoglobin of less than 10 or their platelet count is less than 150,000, those would be indications. If the patient was having bleeding associated with a low platelet count, that would be an indication.
Hyperviscosity-related Symptoms
The one thing I just want to also add is the IgM level. This is not part of the formal criteria, but the higher the IgM level, the higher the risk for a particular patient for getting hyperviscosity-related problems.
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 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.
Why are clinical trials important?
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.
Can you continue cancer treatment?
Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
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 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).
Is WM a rare disease?
WM is a rare disease, and few randomized trials have been conducted. No approved drugs or combination existed for WM until recently, when the US Food and Drug Administration and European Medicines Agency approved ibrutinib. Most data come from phase 2 studies and cross-trial comparisons; there are very few studies directly comparing different regimens ( Table 5 ).
Is WM a recurrent infection?
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.
What is the best treatment for WM?
Ibrutinib (Imbruvica). This is the first drug that the FDA has specifically approved to treat WM. It targets a protein called Bruton’s tyrosine kinase (BTK), which helps cancer cells grow. Ibrutinib is a pill you take once a day.
What is Waldenstrom macroglobulinemia?
Waldenstrom macroglobulinemia (WM) is a rare, slow-growing type of non-Hodgkin’s lymphoma (blood cancer). People with this cancer have high levels of white blood cells and an abnormal protein called monoclonal immunoglobulin M (IgM) in their bone marrow.
How long does it take for plasmapheresis to take place?
The healthy blood flows back from the machine into your body through another IV line. Plasmapheresis takes a few hours.
What is targeted therapy?
Targeted therapy uses drugs that focus on proteins or other substances of cancer cells to stop them from growing. Unlike chemotherapy, it spares healthy cells. Common types of targeted therapy for WM include:
What is it called when you don't have symptoms of WM?
Instead, your doctor may suggest regular visits and blood tests. This is called watchful waiting, or monitoring .
When will blood cancer come back?
Chemotherapy is usually given with targeted drug treatments. Most people with this rare blood cancer will have the disease come back after the first treatment. However, you and your doctor have many options to choose from if this occurs. Last medically reviewed on June 8, 2020.
Can you give carfilzomib as a shot?
Two examples are carfilzomib (Kyprolis) and bortezomib (Velcade). Both are given by infusion through a vein. However, bortezom ib also can be given as a shot under the skin. Side effects include low blood counts, nausea, and pain and numbness in the feet and legs due to nerve damage. mTOR inhibitors.
What is Waldenström macroglobulinemia?
Waldenström macroglobulinemia is a rare hematologic malignancy characterized by an IgM-associated lymphoplasmacytic lymphoma. Often, it is associated with an indolent disease course, and many patients are candidates for careful monitoring.
How long does it take to reevaluate a patient?
If there is any doubt, one should consider reevaluating the patient in 1 to 2 months to determine if there is evidence of disease progression (Gertz, 2018).
What are the symptoms of bone marrow infiltration?
Bone marrow infiltration, seen in 100% of cases, can cause anemia, thrombocytopenia, and neutropenia.
Is rituximab a BTK inhibitor?
Ibrutinib, an oral agent, is a BTK inhibitor typically used as monotherapy.
Is Waldenström macroglobulinemia an indolent disease?
Common clinical features that warrant treatment include anemia, thrombocytopenia, constitutional symptoms, symptomatic hepatosplenomegaly, bulky lymphadenopathy, and hyperviscosity in rare cases (Gertz, 2019). Waldenström macroglobulinemia is an indolent disease and may not result in signs and symptoms for many years.
Coping with physical side effects
ommon physical side effects from each treatment option for Waldenstrom macroglobulinemia are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them .
Coping with emotional and social effects
You can have emotional and social effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones.
Coping with the costs of cancer care
Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan.
Caring for a loved one with cancer
Family members and friends often play an important role in taking care of a person with Waldenstrom macroglobulinemia. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.
Talking with your health care team about side effects
Before starting treatment, talk with your doctor about possible side effects. Ask:
Do I need to start treatment as soon as possible?
Not all people newly diagnosed with Waldenstrom macroglobulinemia need immediate treatment. If you don’t have symptoms, you usually do not need to be treated. One in four people (25 percent) are asymptomatic – meaning without symptoms – when diagnosed. And because WM is a slow-growing lymphoma, you may not have symptoms for many years.
What are the indications that treatment is needed?
Active treatment should only begin when a person becomes symptomatic and the disease is causing problems. Treatment should not be started based on blood tests alone. In the past, increases in IgM levels were used as an indication to start treatment; this is no longer the case, except for those with very high levels.
