Waldenström's macroglobulinemia natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(23 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Waldenström's macroglobulinemia}}
{{Waldenström's macroglobulinemia}}
{{CMG}}{{AE}}{{S.M.}}{{RAK}}
{{CMG}}; {{AE}} {{S.M.}}, {{RAK}}; {{GRR}} {{Nat}}


==Overview==
==Overview==
If left untreated, patients with asymptomatic Waldenström macroglobulinemia may progress to develop [[fatigue]], [[weight loss]], [[peripheral neuropathy]] and other symptoms of the disease. Common complications of Waldenström macroglobulinemia include: [[hyperviscosity syndrome]], [[Cold agglutinin disease|cold haemagglutinin disease]], [[cryoglobulinemia]], [[peripheral neuropathy]], [[primary amyloidosis]], [[Renal insufficiency|renal insufficiency,]] [[Diarrhea|malabsorbtive diarrhea]], and [[Blurred vision|visual abnormalities]]. [[Prognosis]] varies depending on the various factors involved. Five year survival rate is 87% for low-risk disease and 36% for high-risk disease.
If left untreated, [[patients]] with [[asymptomatic]] [[disease]] may progress to [[Development|develop]] [[fatigue]], [[weight loss]], [[peripheral neuropathy]], [[shortness of breath]], [[purpura]], [[raynaud's phenomenon]], and [[vision problems]]. Common [[complications]] of [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]] include: [[hyperviscosity syndrome]], [[Cold agglutinin disease|cold haemagglutinin disease]], [[cryoglobulinemia]], [[peripheral neuropathy]], [[primary amyloidosis]], [[Renal insufficiency|renal insufficiency,]] [[Malabsorption|malabsorptive]] [[diarrhea]], [[Blurred vision|visual abnormalities]], [[congestive heart failure]], and [[schnitzler syndrome]]. Late and [[rare]] severe [[complications]] include [[Richter's transformation|richter syndrome]], and [[bing-Neel syndrome]]. [[Prognosis]] varies [[Dependent variable|depending]] on the various factors involved. [[Five year survival rate]] is 87% for low-[[RiskMetrics|risk]] [[disease]] and 36% for high-[[RiskMetrics|risk]] [[disease]]. A [[Standardized moment|standardized]] [[Scoring rule|scoring]] [[system]] known as the International [[Prognostic]][[Staging (pathology)|Staging]] [[System]] for [[Waldenström's macroglobulinemia|Waldenström's Macroglobulinemia]] (IPSSWM) [[Risk stratification tools|risk stratifies]] the [[patients]] with [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
=== Natural History ===
=== Natural History ===
*The symptoms of Waldenström macroglobulinemia usually develop in the seventh and eighth decade of life, and it will typically start with symptoms such as [[fatigue]], unexplained weight loss, [[peripheral neuropathy]], [[Dyspnea|shortness of breath]], [[purpura]], [[raynaud's phenomenon]], and [[Blurred vision|vision problems]].<ref name="pmid22139816">{{cite journal| author=Wang H, Chen Y, Li F, Delasalle K, Wang J, Alexanian R et al.| title=Temporal and geographic variations of Waldenstrom macroglobulinemia incidence: a large population-based study. | journal=Cancer | year= 2012 | volume= 118 | issue= 15 | pages= 3793-800 | pmid=22139816 | doi=10.1002/cncr.26627 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22139816  }} </ref>
====Initial symptoms====
*[[Symptoms]] of [[Waldenström's macroglobulinemia|Waldenstrom's macroglobulinemia]] usually [[Development|develop]] in the seventh and eighth decade of [[life]]
*It will typically start with [[symptoms]] such as:
**[[Fatigue]]
**Unexplained [[weight loss]]
**[[Numbness]] and [[tingling]] [[Association (statistics)|associated]] with [[peripheral neuropathy]]
**[[Dyspnea|Shortness of breath]]
**[[Purpura]]
**[[Raynaud's phenomenon]]
**[[Blurred vision|Vision problems]] such as [[blurred vision]], [[vision loss]] or [[Blind spot (vision)|blind spots]]<ref name="pmid22139816">{{cite journal| author=Wang H, Chen Y, Li F, Delasalle K, Wang J, Alexanian R et al.| title=Temporal and geographic variations of Waldenstrom macroglobulinemia incidence: a large population-based study. | journal=Cancer | year= 2012 | volume= 118 | issue= 15 | pages= 3793-800 | pmid=22139816 | doi=10.1002/cncr.26627 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22139816  }} </ref>


=== Complications ===
==== Complications ====
* Common complications of Waldenström macroglobulinemia include:
* As the [[disease]] progresses, the following [[complications]] can commonly occur in [[patients]] with [[lymphoplasmacytic lymphoma|Waldenstrom's macroglobulinemia]]:
** [[Hyperviscosity syndrome]]<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref>
**[[Hyperviscosity syndrome|Hyperviscosity syndrome]]<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref>
** [[Cryoglobulinemia]]<ref name="pmid14871241">{{cite journal| author=Michael AB, Lawes M, Kamalarajan M, Huissoon A, Pratt G| title=Cryoglobulinaemia as an acute presentation of Waldenstrom's macroglobulinaemia. | journal=Br J Haematol | year= 2004 | volume= 124 | issue= 5 | pages= 565 | pmid=14871241 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14871241  }} </ref>
** [[Cryoglobulinemia|Cryoglobulinemia]]<ref name="pmid14871241">{{cite journal| author=Michael AB, Lawes M, Kamalarajan M, Huissoon A, Pratt G| title=Cryoglobulinaemia as an acute presentation of Waldenstrom's macroglobulinaemia. | journal=Br J Haematol | year= 2004 | volume= 124 | issue= 5 | pages= 565 | pmid=14871241 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14871241  }} </ref>
** [[Peripheral neuropathy]](15%).<ref name="pmid16421127">{{cite journal| author=Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T et al.| title=Peripheral neuropathies in Waldenström's macroglobulinaemia. | journal=J Neurol Neurosurg Psychiatry | year= 2006 | volume= 77 | issue= 2 | pages= 224-8 | pmid=16421127 | doi=10.1136/jnnp.2005.071175 | pmc=2077569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16421127  }} </ref>
** [[Peripheral neuropathy]](15%)<ref name="pmid16421127">{{cite journal| author=Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T et al.| title=Peripheral neuropathies in Waldenström's macroglobulinaemia. | journal=J Neurol Neurosurg Psychiatry | year= 2006 | volume= 77 | issue= 2 | pages= 224-8 | pmid=16421127 | doi=10.1136/jnnp.2005.071175 | pmc=2077569 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16421127  }} </ref>
** [[Amyloidosis]] of the heart, kidney, liver, lungs, and joints<ref name="pa">{{cite journal |vauthors=Zimmermann I, Gloor HJ, Rüttimann S |title=[General AL-amyloidosis: a rare complication in Waldenstrom macroglobulinemia] |language=German |journal=Praxis (Bern 1994) |volume=90 |issue=47 |pages=2050–5 |year=2001 |pmid=11763619 |doi= |url=}}</ref>
** [[Amyloidosis]] of the [[heart]], [[kidney]], [[liver]], [[lungs]], and [[Joints|joints]]<ref name="pa">{{cite journal |vauthors=Zimmermann I, Gloor HJ, Rüttimann S |title=[General AL-amyloidosis: a rare complication in Waldenstrom macroglobulinemia] |language=German |journal=Praxis (Bern 1994) |volume=90 |issue=47 |pages=2050–5 |year=2001 |pmid=11763619 |doi= |url=}}</ref>
** [[Cold agglutinin disease|Cold haemagglutinin disease]]/Autoimmune hemolytic anemia(<10%).<ref name="pmid24528152">{{cite journal| author=Owen RG, Pratt G, Auer RL, Flatley R, Kyriakou C, Lunn MP et al.| title=Guidelines on the diagnosis and management of Waldenström macroglobulinaemia. | journal=Br J Haematol | year= 2014 | volume= 165 | issue= 3 | pages= 316-33 | pmid=24528152 | doi=10.1111/bjh.12760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24528152  }} </ref>
** [[Cold agglutinin disease|Cold haemagglutinin disease]]/[[Autoimmune hemolytic anemia]](<10%)<ref name="pmid24528152">{{cite journal| author=Owen RG, Pratt G, Auer RL, Flatley R, Kyriakou C, Lunn MP et al.| title=Guidelines on the diagnosis and management of Waldenström macroglobulinaemia. | journal=Br J Haematol | year= 2014 | volume= 165 | issue= 3 | pages= 316-33 | pmid=24528152 | doi=10.1111/bjh.12760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24528152  }} </ref>
** [[Malabsorption|Gastrointestinal malabsorption]]<ref name="pmid3141496">{{cite journal| author=Veloso FT, Fraga J, Saleiro JV| title=Macroglobulinemia and small intestinal disease. A case report with review of the literature. | journal=J Clin Gastroenterol | year= 1988 | volume= 10 | issue= 5 | pages= 546-50 | pmid=3141496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3141496  }} </ref>
** [[Malabsorption|Gastrointestinal malabsorption]]<ref name="pmid3141496">{{cite journal| author=Veloso FT, Fraga J, Saleiro JV| title=Macroglobulinemia and small intestinal disease. A case report with review of the literature. | journal=J Clin Gastroenterol | year= 1988 | volume= 10 | issue= 5 | pages= 546-50 | pmid=3141496 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3141496  }} </ref>
** [[Renal insufficiency]]<ref name="pmid27468978">{{cite journal| author=Vos JM, Gustine J, Rennke HG, Hunter Z, Manning RJ, Dubeau TE et al.| title=Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes. | journal=Br J Haematol | year= 2016 | volume= 175 | issue= 4 | pages= 623-630 | pmid=27468978 | doi=10.1111/bjh.14279 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27468978  }} </ref>
** [[Renal insufficiency|Renal insufficiency]]<ref name="pmid27468978">{{cite journal| author=Vos JM, Gustine J, Rennke HG, Hunter Z, Manning RJ, Dubeau TE et al.| title=Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes. | journal=Br J Haematol | year= 2016 | volume= 175 | issue= 4 | pages= 623-630 | pmid=27468978 | doi=10.1111/bjh.14279 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27468978  }} </ref>
** [[Fundoscopy|Fundoscopic]] abnormalities<ref name="pmid11736938" />
** [[Fundoscopy|Fundoscopic]] [[abnormalities]]<ref name="pmid11736938" />
**[[Congestive heart failure]].
**[[Congestive heart failure]]
**[[Schnitzler syndrome]] which is an autoimmune complication associated with elevated IgM levels, that leads to fever, itchy skin lesions, and joint aches.
**[[Schnitzler syndrome]] which is an [[autoimmune]] [[Complication (medicine)|complication]] [[Association (statistics)|associated]] with elevated [[IgM]] levels, that [[Lead|leads]] to [[fever]], [[itchy skin]] [[lesions]], and [[joint aches]]
====Late and rare complications====
 
*[[Large cell transformation]] ([[Richter syndrome]]).
==== Late and rare severe complications ====
**Dr. Richter of the University of Minnesota first recognized the blockage in maturity of the lymphoma cells at a point when they can't mature beyond the large cell stage thus, leading to large cell transformation.
*[[Large cell]] [[Transformation (genetics)|transformation]] ([[Richter's transformation|Richter syndrome]]):
*[[Central Nervous system Lymphoma]] ([[Bing-Neel syndrome]]).
**[[Doctor of Medicine|Dr]]. [[Richter's transformation|Richter]] of the [[University of Minnesota Medical Center|University of Minnesota]] first [[Recognition sequence|recognized]] the blockage in [[Maturity (psychological)|maturity]] of the [[lymphoma]] [[Cells (biology)|cells]] at a point when they can't [[Maturity (psychological)|mature]] beyond the [[large cell]] [[Stages of human development|stage]] thus, [[Lead|leading]] to [[large cell]] [[Transformation (genetics)|transformation]]
**The development of Waldenström macroglobulinemia cells in the central nervous system was first described by Drs. Bing and Neel and carries their names as the Bing-Neel syndrome. WM involves CNS in following two forms:
*[[Central nervous system]] [[Lymphoma]] ([[Bing-Neel syndrome]]):<ref name="pmid9686227">{{cite journal| author=Civit T, Coulbois S, Baylac F, Taillandier L, Auque J| title=[Waldenström's macroglobulinemia and cerebral lymphoplasmocytic proliferation: Bing and Neel syndrome. Apropos of a new case]. | journal=Neurochirurgie | year= 1997 | volume= 43 | issue= 4 | pages= 245-9 | pmid=9686227 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9686227  }} </ref>
***Actual tumor developing in the brain substance causing seizures and paralysis.
**The [[Development (biology)|development]] of [[Waldenström macroglobulinemia]] [[Cells (biology)|cells]] in the [[central nervous system]] was first described by [[Doctor of Medicine|Drs]]. [[Bing–Neel syndrome|Bing]] and Neel and [[Carrying capacity|carries]] their names as the [[Bing-Neel syndrome]]. [[Waldenström's macroglobulinemia|WM]] involves [[CNS]] in following two forms:
***Tumor cells invading meninges and cranial nerves without causing the actual tumors and with or without CSF cryoglobulinemia,<ref name="pmid19362988">{{cite journal| author=Fintelmann F, Forghani R, Schaefer PW, Hochberg EP, Hochberg FH| title=Bing-Neel Syndrome revisited. | journal=Clin Lymphoma Myeloma | year= 2009 | volume= 9 | issue= 1 | pages= 104-6 | pmid=19362988 | doi=10.3816/CLM.2009.n.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19362988  }} </ref> leading to following symptoms:<ref name="pmid19951888">{{cite journal| author=Grewal JS, Brar PK, Sahijdak WM, Tworek JA, Chottiner EG| title=Bing-Neel syndrome: a case report and systematic review of clinical manifestations, diagnosis, and treatment options. | journal=Clin Lymphoma Myeloma | year= 2009 | volume= 9 | issue= 6 | pages= 462-6 | pmid=19951888 | doi=10.3816/CLM.2009.n.091 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19951888  }} </ref>
***Actual [[tumor]] [[Development (biology)|developing]] in the [[brain]] [[substance]] [[Causes|causing]] [[seizures]] and [[paralysis]]
****Headache.
***[[Tumor cell|Tumor cells]] [[Invasive|invading]] [[meninges]] and [[cranial nerves]] without [[Causes|causing]] the actual [[tumors]] and with or without [[CSF]] [[cryoglobulinemia]],<ref name="pmid19362988">{{cite journal| author=Fintelmann F, Forghani R, Schaefer PW, Hochberg EP, Hochberg FH| title=Bing-Neel Syndrome revisited. | journal=Clin Lymphoma Myeloma | year= 2009 | volume= 9 | issue= 1 | pages= 104-6 | pmid=19362988 | doi=10.3816/CLM.2009.n.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19362988  }} </ref> [[Lead|leading]] to the following [[Symptom|symptoms]]:<ref name="pmid19951888">{{cite journal| author=Grewal JS, Brar PK, Sahijdak WM, Tworek JA, Chottiner EG| title=Bing-Neel syndrome: a case report and systematic review of clinical manifestations, diagnosis, and treatment options. | journal=Clin Lymphoma Myeloma | year= 2009 | volume= 9 | issue= 6 | pages= 462-6 | pmid=19951888 | doi=10.3816/CLM.2009.n.091 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19951888  }} </ref>
****Confusion.
****[[Headache]]
****Neck stiffness.
****[[Confusion]]
****Sporadic loss of motor function.
****[[Neck stiffness]]
****Facial paralysis.
****Sporadic loss of [[Motor skill|motor]] [[Function (biology)|function]]
****Drooping eyelid.
****[[Facial paralysis]]
****Double vision.
****[[Drooping eyelid]]
****Difficult swallowing.
****[[Double vision]]
****Visual loss.
****[[Difficult swallowing]]
****Hearing loss.
****[[Visual loss]]
****[[Hearing loss]]
 
====Summary of natural history and complications of Waldenstrom's macroglobulinemia====
{{Family tree/start}}
{{Family tree |boxstyle=width: 200px; text-align: left;| | A01 | |A01= '''Initial symptoms'''
*[[Fatigue]]
*Unexplained [[weight loss]]
*[[Numbness]] and [[tingling]] [[associated]] with [[peripheral neuropathy]]
*[[Dyspnea|Shortness of breath]]
*[[Purpura]]
*[[Raynaud's phenomenon]]
*[[Blurred vision|Vision problems]] such as [[blurred vision]], [[vision loss]] or blind spots}}
{{Family tree | | |!| | }}
{{Family tree |boxstyle=text-align: left;| | B01 | |B01= '''Common complications'''
*[[Hyperviscosity syndrome|Hyperviscosity syndrome]]
*[[Cryoglobulinemia|Cryoglobulinemia]]
*[[Peripheral neuropathy]] (15%)
*[[Amyloidosis]] of the [[heart]], [[kidney]], [[liver]], [[lungs]], and [[Joints|joints]]
*[[Cold agglutinin disease|Cold haemagglutinin disease]]/[[Autoimmune hemolytic anemia]] (<10%)
*[[Malabsorption|Gastrointestinal malabsorption]]
*[[Renal insufficiency|Renal insufficiency]]
*[[Fundoscopy|Fundoscopic]] [[abnormalities]]
*[[Congestive heart failure]]
*[[Schnitzler syndrome]] which is associated with:
:*Elevated [[IgM]] levels
:*[[Fever]]
:*Itchy [[skin]] lesions
:*[[Joint aches]]}}
{{Family tree | | |!| |}}
{{Family tree |boxstyle=text-align: left;| | C01 | |C01= '''Late and rare severe complications'''
*Large cell [[Transformation (genetics)|transformation]] (Richter [[syndrome]])
*[[Central nervous system]] [[Lymphoma]] ([[Bing-Neel syndrome]])}}
{{Family tree/end}}


=== Prognosis ===
=== Prognosis ===
*Prognosis is generally poor, and the median survival of patients with Waldenström macroglobulinemia varies from 5 to 11 years.<ref name="MorelDuhamel2009">{{cite journal|last1=Morel|first1=P.|last2=Duhamel|first2=A.|last3=Gobbi|first3=P.|last4=Dimopoulos|first4=M. A.|last5=Dhodapkar|first5=M. V.|last6=McCoy|first6=J.|last7=Crowley|first7=J.|last8=Ocio|first8=E. M.|last9=Garcia-Sanz|first9=R.|last10=Treon|first10=S. P.|last11=Leblond|first11=V.|last12=Kyle|first12=R. A.|last13=Barlogie|first13=B.|last14=Merlini|first14=G.|title=International prognostic scoring system for Waldenstrom macroglobulinemia|journal=Blood|volume=113|issue=18|year=2009|pages=4163–4170|issn=0006-4971|doi=10.1182/blood-2008-08-174961}}</ref>
*[[Prognosis]] is [[Generality|generally]] poor
*5-year survival is 78%.
*The [[median]] [[Survival analysis|survival]] from the [[Time series|time]] of [[diagnosis]] is 6.4 [[Year|years]]<ref name="pmid16611306">{{cite journal| author=Ghobrial IM, Fonseca R, Gertz MA, Plevak MF, Larson DR, Therneau TM et al.| title=Prognostic model for disease-specific and overall mortality in newly diagnosed symptomatic patients with Waldenstrom macroglobulinaemia. | journal=Br J Haematol | year= 2006 | volume= 133 | issue= 2 | pages= 158-64 | pmid=16611306 | doi=10.1111/j.1365-2141.2006.06003.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16611306  }} </ref>
*The presence of symptoms is associated with a particularly poor prognosis among patients with the disease.
*The [[median]] [[disease]]-[[Specific activity|specific]] [[Survival analysis|survival]] is 11.2 [[Year|years]]<ref name="pmid16611306">{{cite journal| author=Ghobrial IM, Fonseca R, Gertz MA, Plevak MF, Larson DR, Therneau TM et al.| title=Prognostic model for disease-specific and overall mortality in newly diagnosed symptomatic patients with Waldenstrom macroglobulinaemia. | journal=Br J Haematol | year= 2006 | volume= 133 | issue= 2 | pages= 158-64 | pmid=16611306 | doi=10.1111/j.1365-2141.2006.06003.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16611306  }} </ref>
*Prognosis of [[asymptomatic]] patients is similar to that of the general population.<ref name="pmid15756000">{{cite journal| author=Gobbi PG, Baldini L, Broglia C, Goldaniga M, Comelli M, Morel P et al.| title=Prognostic validation of the international classification of immunoglobulin M gammopathies: a survival advantage for patients with immunoglobulin M monoclonal gammopathy of undetermined significance? | journal=Clin Cancer Res | year= 2005 | volume= 11 | issue= 5 | pages= 1786-90 | pmid=15756000 | doi=10.1158/1078-0432.CCR-04-1899 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15756000  }} </ref>
*Approximately 10% [[patients]] still [[Life|live]] uptil 15 [[Year|years]]<ref name="MorelDuhamel2009">{{cite journal|last1=Morel|first1=P.|last2=Duhamel|first2=A.|last3=Gobbi|first3=P.|last4=Dimopoulos|first4=M. A.|last5=Dhodapkar|first5=M. V.|last6=McCoy|first6=J.|last7=Crowley|first7=J.|last8=Ocio|first8=E. M.|last9=Garcia-Sanz|first9=R.|last10=Treon|first10=S. P.|last11=Leblond|first11=V.|last12=Kyle|first12=R. A.|last13=Barlogie|first13=B.|last14=Merlini|first14=G.|title=International prognostic scoring system for Waldenstrom macroglobulinemia|journal=Blood|volume=113|issue=18|year=2009|pages=4163–4170|issn=0006-4971|doi=10.1182/blood-2008-08-174961}}</ref><ref name="pmid10792277">{{cite journal| author=Kyle RA, Greipp PR, Gertz MA, Witzig TE, Lust JA, Lacy MQ et al.| title=Waldenström's macroglobulinaemia: a prospective study comparing daily with intermittent oral chlorambucil. | journal=Br J Haematol | year= 2000 | volume= 108 | issue= 4 | pages= 737-42 | pmid=10792277 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10792277  }} </ref>
====Risk Stratification Criteria====
*5-[[year]] [[survival rate]] is 78%
Several systems have been proposed to risk stratify patients with Waldenström macroglobulinemia; however, recently, a standardized scoring system has been developed: the International prognostic scoring system for Waldenström macroglobulinemia (IPSSWM):<ref name="pmid19196866">{{cite journal| author=Morel P, Duhamel A, Gobbi P, Dimopoulos MA, Dhodapkar MV, McCoy J et al.| title=International prognostic scoring system for Waldenstrom macroglobulinemia. | journal=Blood | year= 2009 | volume= 113 | issue= 18 | pages= 4163-70 | pmid=19196866 | doi=10.1182/blood-2008-08-174961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19196866  }} </ref>
*In the last decade (2001-2010), the [[median]] overall [[Survival analysis|survival]] for all [[Waldenström's macroglobulinemia|WM]] [[Group (sociology)|groups]] has [[Improving agent|improved]] to just over 8 [[Year|years]] [[Comparability|compared]] to 6 [[Year|years]] in the previous decade (1991-2000)
*[[Case-based reasoning|Cases]] without [[MYD88]] [[mutations]] are [[Association (statistics)|associated]] with [[adenopathy]] and a worse [[outcome]]<ref name="pmid24553177">{{cite journal| author=Treon SP, Cao Y, Xu L, Yang G, Liu X, Hunter ZR| title=Somatic mutations in MYD88 and CXCR4 are determinants of clinical presentation and overall survival in Waldenstrom macroglobulinemia. | journal=Blood | year= 2014 | volume= 123 | issue= 18 | pages= 2791-6 | pmid=24553177 | doi=10.1182/blood-2014-01-550905 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24553177  }} </ref>
*After 2000, a 2-fold increased [[mortality]] is [[Reporting disease cases|reported]] in [[patients]] [[Diagnosis|diagnosed]] with [[Waldenström's macroglobulinemia|WM]] when [[Comparability|compared]] with [[Expected value|expected]] [[population]] [[mortality]]<ref name="KyleLarson2018">{{cite journal|last1=Kyle|first1=Robert A.|last2=Larson|first2=Dirk R.|last3=McPhail|first3=Ellen D.|last4=Therneau|first4=Terry M.|last5=Dispenzieri|first5=Angela|last6=Kumar|first6=Shaji|last7=Kapoor|first7=Prashant|last8=Cerhan|first8=James R.|last9=Rajkumar|first9=S. Vincent|title=Fifty-Year Incidence of Waldenström Macroglobulinemia in Olmsted County, Minnesota, From 1961 Through 2010: A Population-Based Study With Complete Case Capture and Hematopathologic Review|journal=Mayo Clinic Proceedings|volume=93|issue=6|year=2018|pages=739–746|issn=00256196|doi=10.1016/j.mayocp.2018.02.011}}</ref>
*The [[Presenting symptom|presence]] of [[symptoms]] is [[Association (statistics)|associated]] with a particularly poor [[prognosis]] among [[patients]] with the [[disease]]
*[[Prognosis]] of [[asymptomatic]] [[patients]] is [[Similarity matrix|similar]] to that of the [[Generalization|general]] [[population]] with a 10-[[year]] [[survival rate]] of 70-75%<ref name="pmid20702770">{{cite journal| author=Ansell SM, Kyle RA, Reeder CB, Fonseca R, Mikhael JR, Morice WG et al.| title=Diagnosis and management of Waldenström macroglobulinemia: Mayo stratification of macroglobulinemia and risk-adapted therapy (mSMART) guidelines. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 9 | pages= 824-33 | pmid=20702770 | doi=10.4065/mcp.2010.0304 | pmc=2931618 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20702770  }} </ref><ref name="pmid15756000">{{cite journal| author=Gobbi PG, Baldini L, Broglia C, Goldaniga M, Comelli M, Morel P et al.| title=Prognostic validation of the international classification of immunoglobulin M gammopathies: a survival advantage for patients with immunoglobulin M monoclonal gammopathy of undetermined significance? | journal=Clin Cancer Res | year= 2005 | volume= 11 | issue= 5 | pages= 1786-90 | pmid=15756000 | doi=10.1158/1078-0432.CCR-04-1899 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15756000  }} </ref>
 
===Adverse prognostic factors===
*Some of the pretreatment factors associated with shorter [[Survival analysis|survival]] in [[Waldenström's macroglobulinemia|WM]] [[patients]] are:<ref name="pmid12881396">{{cite journal| author=Dimopoulos MA, Hamilos G, Zervas K, Symeonidis A, Kouvatseas G, Roussou P et al.| title=Survival and prognostic factors after initiation of treatment in Waldenstrom's macroglobulinemia. | journal=Ann Oncol | year= 2003 | volume= 14 | issue= 8 | pages= 1299-305 | pmid=12881396 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12881396  }} </ref><ref name="pmid16611306">{{cite journal| author=Ghobrial IM, Fonseca R, Gertz MA, Plevak MF, Larson DR, Therneau TM et al.| title=Prognostic model for disease-specific and overall mortality in newly diagnosed symptomatic patients with Waldenstrom macroglobulinaemia. | journal=Br J Haematol | year= 2006 | volume= 133 | issue= 2 | pages= 158-64 | pmid=16611306 | doi=10.1111/j.1365-2141.2006.06003.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16611306  }} </ref>
**[[Clinical]] [[Parameter|parameters]]:
***[[Age]] >/=65 [[Year|years]]
***[[Hyperviscosity]] [[symptoms]]
***[[Organomegaly|Bulky organomegaly]] ([[Hepatosplenomegaly]])
***[[Bulking agents|Bulky]] [[lymphadenopathy]]
***[[B symptoms]] ([[weight loss]], [[fever]] or [[night sweats]])
***[[Presenting symptom|Presence]] of [[symptomatic]] or unresponsive [[neuropathy]]
***[[Hemolytic anemia]]
**[[Medical laboratory|Laboratory]] [[Parameter|parameters]]:
***[[Hemoglobin]] < 10.0 g/dl)
***[[Platelets]] <100 x 10(6)/dl
***[[Albumin]] <3.5 g/dl
***[[Bone marrow]] lymphoplasmacytic [[Infiltration (medical)|infiltrate]] >/=50%
***Elevated beta2-microglobulin ([[Association (statistics)|associated]] with 3-fold increase in [[Death Cap|death]])
***[[Leucopenia]] (<4.0 x 10(9)/l)
***[[Thrombocytopenia]] (<150 x 10(9)/l)
***[[Quantitative]] [[IgM]] < 0.4 g/l
***[[Serum]] free [[light chain]]<ref name="pmid18452095">{{cite journal| author=Leleu X, Moreau AS, Weller E, Roccaro AM, Coiteux V, Manning R et al.| title=Serum immunoglobulin free light chain correlates with tumor burden markers in Waldenstrom macroglobulinemia. | journal=Leuk Lymphoma | year= 2008 | volume= 49 | issue= 6 | pages= 1104-7 | pmid=18452095 | doi=10.1080/10428190802074619 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18452095  }} </ref>
***[[Serum]] [[lactate dehydrogenase]]<ref name="pmid19362972">{{cite journal| author=Kastritis E, Zervas K, Repoussis P, Michali E, Katodrytou E, Zomas A et al.| title=Prognostication in young and old patients with Waldenström's macroglobulinemia: importance of the International Prognostic Scoring System and of serum lactate dehydrogenase. | journal=Clin Lymphoma Myeloma | year= 2009 | volume= 9 | issue= 1 | pages= 50-2 | pmid=19362972 | doi=10.3816/CLM.2009.n.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19362972  }} </ref>
***[[Serum]] [[soluble]] [[CD27]]<ref name="pmid18216294">{{cite journal| author=Ho AW, Hatjiharissi E, Ciccarelli BT, Branagan AR, Hunter ZR, Leleu X et al.| title=CD27-CD70 interactions in the pathogenesis of Waldenstrom macroglobulinemia. | journal=Blood | year= 2008 | volume= 112 | issue= 12 | pages= 4683-9 | pmid=18216294 | doi=10.1182/blood-2007-04-084525 | pmc=2597134 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18216294  }} </ref>
*Most of the [[prognostic]] factors have defined the [[outcome]] of [[lymphoplasmacytic lymphoma|Waldenstrom's macroglobulinemia]] in [[patients]] requiring [[Treatments|treatment]], however, very few [[Study design|studies]] have evaluated the [[prognostic]] factors in [[patients]] who don't initially need the [[Treatments|treatment]]
 
===Risk Stratification Criteria===
All the above [[prognostic]] [[data]] has been [[Combinational logic|combined]] to [[Risk stratification tools|risk stratify]] the [[Waldenström's macroglobulinemia|WM]] [[patients]] and to [[Formulation|formulate]] a [[Standardized moment|standardized]] [[Scoring rule|scoring]] [[system]] known as '''the International Prognostic Staging System for Waldenström's Macroglobulinemia (IPSSWM)''':<ref name="pmid19196866">{{cite journal| author=Morel P, Duhamel A, Gobbi P, Dimopoulos MA, Dhodapkar MV, McCoy J et al.| title=International prognostic scoring system for Waldenstrom macroglobulinemia. | journal=Blood | year= 2009 | volume= 113 | issue= 18 | pages= 4163-70 | pmid=19196866 | doi=10.1182/blood-2008-08-174961 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19196866  }} </ref>


{| class="wikitable"
{| class="wikitable"
Line 53: Line 125:
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Score
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Score
|-
|-
| style="background:#DCDCDC;" align="center" + |Age > 65
! style="background:#DCDCDC;" align="center" + |[[Age]] > 65
| style="background:#F5F5F5;" align="center" + |1
| style="background:#F5F5F5;" align="center" + |1
|-
|-
| style="background:#DCDCDC;" align="center" + |Hemoglobin ≤ 11.5g/dl
! style="background:#DCDCDC;" align="center" + |[[Hemoglobin]] ≤ 11.5g/dl
| style="background:#F5F5F5;" align="center" + |1
| style="background:#F5F5F5;" align="center" + |1
|-
|-
| style="background:#DCDCDC;" align="center" + |Platelet ≤ 100,000μl
! style="background:#DCDCDC;" align="center" + |[[Platelet]] ≤ 100,000μl
| style="background:#F5F5F5;" align="center" + |1
| style="background:#F5F5F5;" align="center" + |1
|-
|-
| style="background:#DCDCDC;" align="center" + |β-microglobulin > 3mg/l
! style="background:#DCDCDC;" align="center" + |β-microglobulin > 3mg/l
| style="background:#F5F5F5;" align="center" + |1
| style="background:#F5F5F5;" align="center" + |1
|-
|-
| style="background:#DCDCDC;" align="center" + |IgM > 70g/l
! style="background:#DCDCDC;" align="center" + |[[Immunoglobulin M|IgM]] > 70g/l
| style="background:#F5F5F5;" align="center" + |1
| style="background:#F5F5F5;" align="center" + |1
|}
|}
Line 73: Line 145:
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Score
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Score
! style="background:#4479BA; color: #FFFFFF;" align="center" + |5-year survival
! style="background:#4479BA; color: #FFFFFF;" align="center" + |5-year survival
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Median survival
|-
|-
| style="background:#DCDCDC;" align="center" + |Low
! style="background:#DCDCDC;" align="center" + |Low
| style="background:#F5F5F5;" align="center" + |0-1 (except age)
| style="background:#F5F5F5;" align="center" + |0-1 (except age)
| style="background:#F5F5F5;" align="center" + |87%
| style="background:#F5F5F5;" align="center" + |87%
| style="background:#F5F5F5;" align="center" + |12 years
|-
|-
| style="background:#DCDCDC;" align="center" + |Intermediate
! style="background:#DCDCDC;" align="center" + |Intermediate
| style="background:#F5F5F5;" align="center" + |2 or age>65
| style="background:#F5F5F5;" align="center" + |2 or age>65
| style="background:#F5F5F5;" align="center" + |68%
| style="background:#F5F5F5;" align="center" + |68%
| style="background:#F5F5F5;" align="center" + |8 years
|-
|-
| style="background:#DCDCDC;" align="center" + |High
! style="background:#DCDCDC;" align="center" + |High
| style="background:#F5F5F5;" align="center" + |≥3
| style="background:#F5F5F5;" align="center" + |≥3
| style="background:#F5F5F5;" align="center" + |36%
| style="background:#F5F5F5;" align="center" + |36%
| style="background:#F5F5F5;" align="center" + |3.5 years
|}
|}


Latest revision as of 18:35, 15 August 2019

Waldenström's macroglobulinemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Waldenström's macroglobulinemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Bone Marrow Aspiration and Biopsy

Electrophoresis and Immunofixation

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Waldenström's macroglobulinemia natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Waldenström's macroglobulinemia natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Waldenström's macroglobulinemia natural history, complications and prognosis

CDC on Waldenström's macroglobulinemia natural history, complications and prognosis

Waldenström's macroglobulinemia natural history, complications and prognosis in the news

Blogs on Waldenström's macroglobulinemia natural history, complications and prognosis

Directions to Hospitals Treating Waldenström's macroglobulinemia

Risk calculators and risk factors for Waldenström's macroglobulinemia natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2], Roukoz A. Karam, M.D.[3]; Grammar Reviewer: Natalie Harpenau, B.S.[4]

Overview

If left untreated, patients with asymptomatic disease may progress to develop fatigue, weight loss, peripheral neuropathy, shortness of breath, purpura, raynaud's phenomenon, and vision problems. Common complications of Waldenstrom's macroglobulinemia include: hyperviscosity syndrome, cold haemagglutinin disease, cryoglobulinemia, peripheral neuropathy, primary amyloidosis, renal insufficiency, malabsorptive diarrhea, visual abnormalities, congestive heart failure, and schnitzler syndrome. Late and rare severe complications include richter syndrome, and bing-Neel syndrome. Prognosis varies depending on the various factors involved. Five year survival rate is 87% for low-risk disease and 36% for high-risk disease. A standardized scoring system known as the International PrognosticStaging System for Waldenström's Macroglobulinemia (IPSSWM) risk stratifies the patients with Waldenstrom's macroglobulinemia.

Natural History, Complications, and Prognosis

Natural History

Initial symptoms

Complications

Late and rare severe complications

Summary of natural history and complications of Waldenstrom's macroglobulinemia

 
Initial symptoms
 
 
 
 
 
 
 
 
Common complications
 
 
 
 
 
 
 
Late and rare severe complications
 

Prognosis

Adverse prognostic factors

Risk Stratification Criteria

All the above prognostic data has been combined to risk stratify the WM patients and to formulate a standardized scoring system known as the International Prognostic Staging System for Waldenström's Macroglobulinemia (IPSSWM):[23]

Risk factors Score
Age > 65 1
Hemoglobin ≤ 11.5g/dl 1
Platelet ≤ 100,000μl 1
β-microglobulin > 3mg/l 1
IgM > 70g/l 1
International prognostic scoring system for Waldenström macroglobulinemia
Risk group Score 5-year survival Median survival
Low 0-1 (except age) 87% 12 years
Intermediate 2 or age>65 68% 8 years
High ≥3 36% 3.5 years

References

  1. ↑ Wang H, Chen Y, Li F, Delasalle K, Wang J, Alexanian R; et al. (2012). "Temporal and geographic variations of Waldenstrom macroglobulinemia incidence: a large population-based study". Cancer. 118 (15): 3793–800. doi:10.1002/cncr.26627. PMID 22139816.
  2. ↑ 2.0 2.1 García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A; et al. (2001). "Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases". Br J Haematol. 115 (3): 575–82. PMID 11736938.
  3. ↑ Michael AB, Lawes M, Kamalarajan M, Huissoon A, Pratt G (2004). "Cryoglobulinaemia as an acute presentation of Waldenstrom's macroglobulinaemia". Br J Haematol. 124 (5): 565. PMID 14871241.
  4. ↑ Levine T, Pestronk A, Florence J, Al-Lozi MT, Lopate G, Miller T; et al. (2006). "Peripheral neuropathies in Waldenström's macroglobulinaemia". J Neurol Neurosurg Psychiatry. 77 (2): 224–8. doi:10.1136/jnnp.2005.071175. PMC 2077569. PMID 16421127.
  5. ↑ Zimmermann I, Gloor HJ, Rüttimann S (2001). "[General AL-amyloidosis: a rare complication in Waldenstrom macroglobulinemia]". Praxis (Bern 1994) (in German). 90 (47): 2050–5. PMID 11763619.
  6. ↑ Owen RG, Pratt G, Auer RL, Flatley R, Kyriakou C, Lunn MP; et al. (2014). "Guidelines on the diagnosis and management of Waldenström macroglobulinaemia". Br J Haematol. 165 (3): 316–33. doi:10.1111/bjh.12760. PMID 24528152.
  7. ↑ Veloso FT, Fraga J, Saleiro JV (1988). "Macroglobulinemia and small intestinal disease. A case report with review of the literature". J Clin Gastroenterol. 10 (5): 546–50. PMID 3141496.
  8. ↑ Vos JM, Gustine J, Rennke HG, Hunter Z, Manning RJ, Dubeau TE; et al. (2016). "Renal disease related to Waldenström macroglobulinaemia: incidence, pathology and clinical outcomes". Br J Haematol. 175 (4): 623–630. doi:10.1111/bjh.14279. PMID 27468978.
  9. ↑ Civit T, Coulbois S, Baylac F, Taillandier L, Auque J (1997). "[Waldenström's macroglobulinemia and cerebral lymphoplasmocytic proliferation: Bing and Neel syndrome. Apropos of a new case]". Neurochirurgie. 43 (4): 245–9. PMID 9686227.
  10. ↑ Fintelmann F, Forghani R, Schaefer PW, Hochberg EP, Hochberg FH (2009). "Bing-Neel Syndrome revisited". Clin Lymphoma Myeloma. 9 (1): 104–6. doi:10.3816/CLM.2009.n.028. PMID 19362988.
  11. ↑ Grewal JS, Brar PK, Sahijdak WM, Tworek JA, Chottiner EG (2009). "Bing-Neel syndrome: a case report and systematic review of clinical manifestations, diagnosis, and treatment options". Clin Lymphoma Myeloma. 9 (6): 462–6. doi:10.3816/CLM.2009.n.091. PMID 19951888.
  12. ↑ 12.0 12.1 12.2 Ghobrial IM, Fonseca R, Gertz MA, Plevak MF, Larson DR, Therneau TM; et al. (2006). "Prognostic model for disease-specific and overall mortality in newly diagnosed symptomatic patients with Waldenstrom macroglobulinaemia". Br J Haematol. 133 (2): 158–64. doi:10.1111/j.1365-2141.2006.06003.x. PMID 16611306.
  13. ↑ Morel, P.; Duhamel, A.; Gobbi, P.; Dimopoulos, M. A.; Dhodapkar, M. V.; McCoy, J.; Crowley, J.; Ocio, E. M.; Garcia-Sanz, R.; Treon, S. P.; Leblond, V.; Kyle, R. A.; Barlogie, B.; Merlini, G. (2009). "International prognostic scoring system for Waldenstrom macroglobulinemia". Blood. 113 (18): 4163–4170. doi:10.1182/blood-2008-08-174961. ISSN 0006-4971.
  14. ↑ Kyle RA, Greipp PR, Gertz MA, Witzig TE, Lust JA, Lacy MQ; et al. (2000). "Waldenström's macroglobulinaemia: a prospective study comparing daily with intermittent oral chlorambucil". Br J Haematol. 108 (4): 737–42. PMID 10792277.
  15. ↑ Treon SP, Cao Y, Xu L, Yang G, Liu X, Hunter ZR (2014). "Somatic mutations in MYD88 and CXCR4 are determinants of clinical presentation and overall survival in Waldenstrom macroglobulinemia". Blood. 123 (18): 2791–6. doi:10.1182/blood-2014-01-550905. PMID 24553177.
  16. ↑ Kyle, Robert A.; Larson, Dirk R.; McPhail, Ellen D.; Therneau, Terry M.; Dispenzieri, Angela; Kumar, Shaji; Kapoor, Prashant; Cerhan, James R.; Rajkumar, S. Vincent (2018). "Fifty-Year Incidence of Waldenström Macroglobulinemia in Olmsted County, Minnesota, From 1961 Through 2010: A Population-Based Study With Complete Case Capture and Hematopathologic Review". Mayo Clinic Proceedings. 93 (6): 739–746. doi:10.1016/j.mayocp.2018.02.011. ISSN 0025-6196.
  17. ↑ Ansell SM, Kyle RA, Reeder CB, Fonseca R, Mikhael JR, Morice WG; et al. (2010). "Diagnosis and management of Waldenström macroglobulinemia: Mayo stratification of macroglobulinemia and risk-adapted therapy (mSMART) guidelines". Mayo Clin Proc. 85 (9): 824–33. doi:10.4065/mcp.2010.0304. PMC 2931618. PMID 20702770.
  18. ↑ Gobbi PG, Baldini L, Broglia C, Goldaniga M, Comelli M, Morel P; et al. (2005). "Prognostic validation of the international classification of immunoglobulin M gammopathies: a survival advantage for patients with immunoglobulin M monoclonal gammopathy of undetermined significance?". Clin Cancer Res. 11 (5): 1786–90. doi:10.1158/1078-0432.CCR-04-1899. PMID 15756000.
  19. ↑ Dimopoulos MA, Hamilos G, Zervas K, Symeonidis A, Kouvatseas G, Roussou P; et al. (2003). "Survival and prognostic factors after initiation of treatment in Waldenstrom's macroglobulinemia". Ann Oncol. 14 (8): 1299–305. PMID 12881396.
  20. ↑ Leleu X, Moreau AS, Weller E, Roccaro AM, Coiteux V, Manning R; et al. (2008). "Serum immunoglobulin free light chain correlates with tumor burden markers in Waldenstrom macroglobulinemia". Leuk Lymphoma. 49 (6): 1104–7. doi:10.1080/10428190802074619. PMID 18452095.
  21. ↑ Kastritis E, Zervas K, Repoussis P, Michali E, Katodrytou E, Zomas A; et al. (2009). "Prognostication in young and old patients with Waldenström's macroglobulinemia: importance of the International Prognostic Scoring System and of serum lactate dehydrogenase". Clin Lymphoma Myeloma. 9 (1): 50–2. doi:10.3816/CLM.2009.n.012. PMID 19362972.
  22. ↑ Ho AW, Hatjiharissi E, Ciccarelli BT, Branagan AR, Hunter ZR, Leleu X; et al. (2008). "CD27-CD70 interactions in the pathogenesis of Waldenstrom macroglobulinemia". Blood. 112 (12): 4683–9. doi:10.1182/blood-2007-04-084525. PMC 2597134. PMID 18216294.
  23. ↑ Morel P, Duhamel A, Gobbi P, Dimopoulos MA, Dhodapkar MV, McCoy J; et al. (2009). "International prognostic scoring system for Waldenstrom macroglobulinemia". Blood. 113 (18): 4163–70. doi:10.1182/blood-2008-08-174961. PMID 19196866.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Waldenström%27s_macroglobulinemia_natural_history,_complications_and_prognosis&oldid=1579727"