Waldenström's macroglobulinemia medical therapy: Difference between revisions

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==Overview==
==Overview==
==Medical Therapy==
==Medical Therapy==
There is no single accepted treatment for WM. Indeed, in 1991, Waldenström himself raised the question of the need for effective therapy.<ref>{{cite journal | author=Waldenstrom J | title=To treat or not to treat, this is the real question | journal=Leuk Res | year=1991 | pages=407-8 | volume=15 | issue=6 | id=PMID 1907339}}</ref> In the absence of symptoms, many clinicians will recommend simply monitoring the patient.
There are several different options for Waldenström Macroglobulinemia.<ref name=Tx>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 </ref>


In 2002, a panel at the International Workshop on Waldenström's Macroglobulinemia agreed on criteria for the initiation of therapy. They recommended starting therapy in patients with constitutional symptoms such as recurrent [[fever]], [[night sweats]], [[fatigue]] due to [[anemia]], [[weight loss]], progressive symptomatic [[lymphadenopathy]] or [[splenomegaly]], and [[anemia]] due to [[bone marrow]] infiltration.  
===Watchful Waiting===
Patients who do not have symptoms and whose cancer does not seem to be progressing often do not need treatment.


Complications such as [[hyperviscosity syndrome]], symptomatic sensorimotor peripheral neuropathy, systemic [[amyloidosis]], [[renal insufficiency]], or symptomatic cryoglobulinemia were also suggested as indications for therapy.<ref name="Kyel2003">{{cite journal | author=Kyle RA, Treon SP, Alexanian R, Barlogie B, Bjorkholm M, Dhodapkar M, Lister TA, Merlini G, Morel P, Stone M, Branagan AR, Leblond V | title=Prognostic markers and criteria to initiate therapy in Waldenstrom's macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom's Macroglobulinemia | journal=Semin Oncol | year=2003 | pages=116-20 | volume=30 | issue=2  | id=PMID 12720119}}</ref>
===Plasmapheresis===
*Plasmapheresis is recommended in patients with Waldenström Macroglobulinemia who develop hyperviscosity symptoms.
*Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes the blood thinner.
*However, plasmapheresis does not affect the lymphoma cells.


Treatment includes the monoclonal antibody [[rituximab]], sometimes in combination with chemotherapeutic drugs such as [[chlorambucil]], [[cyclophosphamide]], or [[vincristine]].  [[Corticosteroid]]s may also be used in combination. [[Plasmapheresis]] can be used to treat the hyperviscosity syndrome by removing the paraprotein from the blood, although it does not address the underlying disease.<ref name="Gertz">{{cite journal | author=Gertz MA | title=Waldenstrom macroglobulinemia: a review of therapy | journal=Am J Hematol | year=2005 | pages=147-57 | volume=79 | issue=2  | id=PMID 15929102}}</ref>
*Plasmapheresis is usually given until chemotherapy starts to work.


Recently, [[autologous bone marrow transplantation]] has been added to the available treatment options.<ref name="Yang">{{cite journal | author=Yang L, Wen B, Li H, Yang M, Jin Y, Yang S, Tao J | title=Autologous peripheral blood stem cell transplantation for Waldenstrom's macroglobulinemia | journal=Bone Marrow Transplant | year=1999 | pages=929-30 | volume=24 | issue=8  | id=PMID 10516708}}</ref><ref name="Martino">{{cite journal | author=Martino R, Shah A, Romero P, Brunet S, Sierra J, Domingo-Albos A, Fruchtman S, Isola L | title=Allogeneic bone marrow transplantation for advanced Waldenstrom's macroglobulinemia | journal=Bone Marrow Transplant | year=1999 | pages=747-9 | volume=23 | issue=7  | id=PMID 10218857}}</ref><ref name="Anagnostopoulos">{{cite journal | author=Anagnostopoulos A, Dimopoulos MA, Aleman A, Weber D, Alexanian R, Champlin R, Giralt S | title=High-dose chemotherapy followed by stem cell transplantation in patients with resistant Waldenstrom's macroglobulinemia | journal=Bone Marrow Transplant | year=2001 | pages=1027-9 | volume=27 | issue=10  | id=PMID 11438816}}</ref><ref name="Tournilhac">{{cite journal | author=Tournilhac O, Leblond V, Tabrizi R, Gressin R, Senecal D, Milpied N, Cazin B, Divine M, Dreyfus B, Cahn JY, Pignon B, Desablens B, Perrier JF, Bay JO, Travade P | title=Transplantation in Waldenstrom's macroglobulinemia--the French experience | journal=Semin Oncol | year=2003 | pages=291-6 | volume=30 | issue=2  | id=PMID 12720155}}</ref>
===Chemotherapy===


==References==
==References==

Revision as of 16:48, 6 November 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

There are several different options for Waldenström Macroglobulinemia.[1]

Watchful Waiting

Patients who do not have symptoms and whose cancer does not seem to be progressing often do not need treatment.

Plasmapheresis

  • Plasmapheresis is recommended in patients with Waldenström Macroglobulinemia who develop hyperviscosity symptoms.
  • Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes the blood thinner.
  • However, plasmapheresis does not affect the lymphoma cells.
  • Plasmapheresis is usually given until chemotherapy starts to work.

Chemotherapy

References

  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

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