What Is Waldenström’s Macroglobulinemia?

Waldenström’s Macroglobulinemia is a lymphoplasmacytic lymphoma, meaning the cancer cells have features of both lymphocytes and plasma cells. These cells accumulate in the bone marrow and release excessive IgM protein, causing:

• Blood thickening (hyperviscosity)

• Reduced production of normal blood cells

• Nerve, organ, and immune system involvement

WM is not curable, but long-term control is highly achievable with modern treatments.

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Causes & Risk Factors

Although the exact cause is unknown, the following factors may increase the risk:

• Increasing age (typically above 60 years)

• Male gender (more common in men)

• Family history of lymphoma or WM

• Certain genetic mutations (e.g., MYD88 mutation)

• Autoimmune or inflammatory conditions

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Symptoms of Waldenström’s Macroglobulinemia

Symptoms vary depending on IgM levels, organ involvement, and blood cell counts. Common signs include:

General Symptoms

• Weakness and fatigue

• Weight loss

• Night sweats

• Fever

Due to Hyperviscosity

• Blurred vision

• Headaches

• Dizziness

• Nosebleeds or gum bleeding

• Confusion (advanced cases)

Due to Low Blood Counts

• Anemia (shortness of breath, tiredness)

• Frequent infections

• Easy bruising

Organ-Related Symptoms

• Enlarged lymph nodes

• Enlarged spleen or liver

• Numbness/tingling in hands or feet (neuropathy)

Any persistent symptoms should prompt immediate evaluation.

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How Is Waldenström’s Macroglobulinemia Diagnosed?

At I D Cancer Center, we use advanced diagnostic tools:

1. Blood Tests

• Complete blood count (CBC)

• IgM protein levels

• Serum protein electrophoresis

• Immunofixation

• Beta-2 microglobulin

2. Bone Marrow Biopsy

Confirms WM by detecting abnormal lymphoplasmacytic cells.

3. Genetic Testing

• MYD88 L265P mutation

• CXCR4 mutation
  These help guide targeted therapy.

4. Imaging

• CT scan

• PET-CT
  Used to assess lymph node or organ involvement.

5. Fundoscopy

Eye examination for blood vessel changes due to hyperviscosity.

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Treatment Options at I D Cancer Center

Treatment depends on symptoms, IgM levels, organ involvement, and patient age. Many patients may not need immediate treatment and can be monitored (watchful waiting).

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1. Targeted Therapy

Modern targeted drugs are highly effective:

• Ibrutinib (BTK inhibitor)

• Zanubrutinib

• Acalabrutinib

These shrink tumors, reduce IgM levels, and are easier to tolerate than traditional chemotherapy.

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2. Chemotherapy

Used alone or in combination with targeted therapies:

• Bendamustine

• Cyclophosphamide

• Fludarabine

Often combined with rituximab (anti-CD20 antibody).

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3. Immunotherapy

• Rituximab (CD20 therapy)

• Combination immunochemotherapy (e.g., BR regimen)

These help control cancer cells and improve blood counts.

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4. Plasmapheresis (Emergency Treatment)

Used during hyperviscosity crisis.

This process rapidly removes excess IgM from the blood to relieve symptoms.

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5. Stem Cell Transplant (Selected Cases)

Autologous stem cell transplant may be an option for younger or relapsed patients.