What are the indications for treatment of Waldenström macroglobulinemia?

Updated: Feb 01, 2021
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Patients who meet the diagnostic criteria for Waldenström macroglobulinemia (WM) on the basis of serum IgM monoclonal protein, bone marrow lymphoplasmacytic infiltration, or both but who do not have evidence of end-organ damage are considered to have indolent disease or smoldering Waldenström macroglobulinemia. No treatment is indicated for asymptomatic disease. [5] Patients can be observed carefully with periodic measurement of the M component, immunoglobulin, and serum viscosity.

Clinical indications for initiation of therapy include the following [29] :

  • Recurrent fever, night sweats, weight loss, fatigue 
  • Hyperviscosity
  • Lymphadenopathy, symptomatic or bulky (≥5 cm in maximum diameter) 
  • Symptomatic hepatomegaly and/or splenomegaly 
  • Symptomatic organomegaly and/or organ or tissue infiltration 
  • Peripheral neuropathy from WM

Laboratory indications for initiation of therapy include the following [29] :

  • Symptomatic cryoglobulinemia 
  • Symptomatic cold agglutinin anemia 
  • Autoimmune hemolytic anemia and/or thrombocytopenia 
  • WM-related nephropathy
  • WM-related amyloidosis
  • Hemoglobin ≤10 g/dL 
  • Platelet count < 100 × 10 9/L 

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