Waldenström's macroglobulinemia medical therapy: Difference between revisions

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Revision as of 20:35, 23 January 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2] Roukoz A. Karam, M.D.[3]

Overview

Risk stratification determines the protocol of management used for Waldenström macroglobulinemia. There is no treatment for asymptomatic Waldenström macroglobulinemia. The mainstay of treatment for symptomatic Waldenström macroglobulinemia is Rituximab +/- Chemotherapy. Hyperviscosity syndrome is a medical emergency and requires prompt treatment with plasmapheresis.

Medical Therapy

There are several different options for treating Waldenström macroglobulinemia depending on stage of the disease:^[1]

Asymptomatic/Smoldering Waldenström's Macroglobulinemia

There is no treatment for asymptomatic Waldenström macroglobulinemia. Asymptomatic waldenström's macroglobulinemia can be monitored every 3-6 months.^[2] Active surveillance includes monitoring of the following laboratory parameters:

Complete blood count (CBC) with differential
Complete metabolic panel (CMP)
Immunoglobulin levels in the serum (quantitative)
Serum protein electrophoresis

Symptomatic Waldenström's Macroglobulinemia

Symptomatic patients with waldenström macroglobulinemia are started on chemotherapy depending on the stage.^[3]

Initial stage of waldenström's macroglobulinemia associated with:

Neuropathy
Anemia or cytopenias
Low-volume nodal involvement
Asymptomatic splenomegaly

Late stage of Waldenström's macroglobulinemia associated with:

Adenopathy
Symptomatic splenomegaly
Cytopenias
Hyperviscosity syndrome
Neuropathy
Constitutional symptoms


Treatment Regimen^[3]	Drugs	Side effects

CHOP-R regimen	Cyclophosphamide Doxorubicin Vincristine Prednisone Rituximab	Nausea Alopecia Granulocytopenia Cardiotoxicity Mucositis
Ibrutinib	Ibrutinib	Fatigue Cytopenia Bleeding Atrial fibrillation Opportunistic infection
Rituximab	Rituximab	Infusion related reaction Hepatitis B reaction Progressive multi-focal leukoencephaloptahy
FR regimen	Fludarabine Rituximab	Neutropenia (63%) Thrombocytopenia Pneumonia
BDR regimen	Bortezomib Dexamethasone Rituximab	Peripheral neuropathy - reversible in 61% of patients Infections
DRC regimen	Dexamethasone Rituximab Cyclophosphamide	Neutropenia
CR regimen	Cladribine Rituximab	Anemia Neurological symptoms Symptomatic cryoglobulinemia Thrombocytopenia
IR regimen	Ibrutinib Rituximab	Anemia Neurological symptoms Symptomatic cryoglobulinemia Thrombocytopenia Atrial fibrillation

Hyperviscosity syndrome

Waldenström macroglobulinemia complicated with hyperviscosity syndrome is a medical emergency and requires prompt treatment with plasmapheresis.^[3]
Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes blood thinner.
Plasmapheresis is usually given until chemotherapy starts to work.
Plasmapheresis is combined with chemotherapy to control the disease for a longer period of time.

References

↑ Lymphoplasmacytic lymphoma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/lymphoplasmacytic-lymphoma/?region=ab Accessed on November 6 2015
↑ Waldenström's macroglobulinemia. Patient (2015)http://patient.info/doctor/waldenstroms-macroglobulinaemia-pro Accessed on November 10, 2015
↑ ^3.0 ^3.1 ^3.2 Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015

Template:WH Template:WS

[Tx-1] Lymphoplasmacytic lymphoma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/lymphoplasmacytic-lymphoma/?region=ab Accessed on November 6 2015

[BM-2] Waldenström's macroglobulinemia. Patient (2015)http://patient.info/doctor/waldenstroms-macroglobulinaemia-pro Accessed on November 10, 2015

[ADR-3] 3.0 ^3.1 ^3.2 Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015

[1]

[2]

[3]

@@ Line 4: / Line 4: @@
 ==Overview==
-Risk stratification determines the protocol of management used for Waldenström macroglobulinemia. There is no treatment for asymptomatic Waldenström macroglobulinemia. The mainstay of treatment for symptomatic Waldenström macroglobulinemia is [[Rituximab]] +/- [[Chemotherapy]]. [[Hyperviscosity syndrome]] is a medical emergency and requires prompt treatment with [[plasmapheresis]].
+[[Risk stratification tools|Risk stratification]] determines the protocol of management used for Waldenström macroglobulinemia. There is no treatment for asymptomatic Waldenström macroglobulinemia. The mainstay of treatment for symptomatic Waldenström macroglobulinemia is [[Rituximab]] +/- [[Chemotherapy]]. [[Hyperviscosity syndrome]] is a medical emergency and requires prompt treatment with [[plasmapheresis]].
@@ Line 12: / Line 12: @@
 ====Asymptomatic/Smoldering Waldenström's Macroglobulinemia====
 There is no treatment for asymptomatic Waldenström macroglobulinemia. Asymptomatic waldenström's macroglobulinemia can be monitored every 3-6 months.<ref name="BM">Waldenström's macroglobulinemia. Patient (2015)http://patient.info/doctor/waldenstroms-macroglobulinaemia-pro Accessed on November 10, 2015</ref> Active surveillance includes monitoring of the following laboratory parameters:
-*Complete blood count (CBC) with differential
+*Complete blood count ([[Complete blood count|CBC]]) with differential
-*Complete metabolic panel (CMP)
+*Complete metabolic panel ([[CMP-N-acetylneuraminate monooxygenase|CMP]])
 *Immunoglobulin levels in the serum (quantitative)
 *Serum protein electrophoresis
@@ Line 27: / Line 27: @@
 *Late stage of Waldenström's macroglobulinemia associated with:
-:*Adenopathy
+:*[[Adenopathy]]
-:*Symptomatic splenomegaly
+:*Symptomatic [[splenomegaly]]
-:*Cytopenias
+:*[[Cytopenia|Cytopenias]]
-:*Hyperviscosity syndrome
+:*[[Hyperviscosity syndrome]]
-:*Neuropathy
+:*[[Neuropathy]]
 :*Constitutional symptoms
@@ Line 43: / Line 43: @@
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
-'''CHOP-R regimen'''
+'''[[CHOP-R regimen]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Cyclophosphamide]]
@@ Line 58: / Line 58: @@
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
-'''Ibrutinib'''
+'''[[Ibrutinib]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Ibrutinib]]
@@ Line 69: / Line 69: @@
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
-'''Rituximab'''
+'''[[Rituximab]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Rituximab]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Infusion related reaction
-*Hepatitis B reaction
+*[[Hepatitis B]] reaction
-*Progressive multifocal leukoencephaloptahy
+*Progressive multi-focal leukoencephaloptahy
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
@@ Line 112: / Line 112: @@
 *[[Rituximab]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Anemia
+*[[Anemia]]
 *Neurological symptoms
 *Symptomatic [[cryoglobulinemia]]
-*Thrombocytopenia
+*[[Thrombocytopenia]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
@@ Line 123: / Line 123: @@
 *[[Rituximab]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Anemia
+*[[Anemia]]
 *Neurological symptoms
 *Symptomatic [[cryoglobulinemia]]
-*Thrombocytopenia
+*[[Thrombocytopenia]]
-*Atrial fibrillation
+*[[Atrial fibrillation]]
 |-
 |}
 ====Hyperviscosity syndrome====
-*Waldenström macroglobulinemia complicated with [[hyperviscosity syndrome]] is a medical emergency and requires prompt treatment with [[plasmapheresis]].<ref name="ADR">Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015</ref>
+*Waldenström macroglobulinemia complicated with [[hyperviscosity syndrome]] is a medical emergency and requires prompt treatment with plasmapheresis.<ref name="ADR">Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015</ref>
-*Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes blood thinner.
+*[[Plasmapheresis]] temporarily lowers [[IgM]] levels by removing some of the abnormal IgM from the blood, which makes blood thinner.
 *Plasmapheresis is usually given until chemotherapy starts to work.
 *Plasmapheresis is combined with chemotherapy to control the disease for a longer period of time.