Waldenström macroglobulinemia: 2013 update on diagnosis, risk stratification, and management

Authors


  • Conflict of interest: Nothing to report.

Correspondence to: Morie A. Gertz, MD, Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: gertz.morie@mayo.edu

Abstract

Disease Overview

Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, and lymphadenopathy.

Diagnosis

The presence of IgM monoclonal protein associated with ≥10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis.

Risk Stratification

Age, hemoglobin level, platelet count, β2 microglobulin, and monoclonal IgM concentrations are characteristics required for prognosis.

Risk-Adapted Therapy

Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Rituximab-based therapy is used in virtually all US patients with WM and can be combined with alkylating agent or purine nucleoside analog (or both). The preferred Mayo Clinic nonstudy therapeutic induction is rituximab, cyclophosphamide, and dexamethasone. Future stem cell transplantation should be considered in induction therapy selection.

Management of Refractory Disease

Bortezomib, thalidomide, everolimus, lenalidomide, and bendamustine have all been shown to have activity in WM. Given WM's natural history, reduction of complications will be a priority for future treatment trials. Am. J. Hematol. 88:703–711, 2013. © 2013 Wiley Periodicals, Inc.

Ancillary