WaldenströM's Macroglobulinemia: Treatment

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Clinical staging, to define how far a cancer has spread through the body, is the common method for choosing a cancer treatment. However, there is no generally-accepted staging system for WM.

There also is no generally-accepted course of treatment for WM. Treatment may not be necessary for asymptomatic macroglobulinemia. However, if IgM serum levels are very high, treatment may be initiated even in the absence of symptoms. If symptoms are present, treatment is directed at relieving symptoms and retarding the disease's development. Of major concern is the prevention or alleviation of blood hyperviscosity. Therefore, the initial treatment depends on the viscosity of the blood at diagnosis.

Plasmapheresis, or plasma exchange transfusion,is a procedure for thinning the blood. In this treatment, blood is removed and passed through a cell separator that removes the plasma, containing the IgM, from the red and white blood cells and platelets. The blood cells are transfused back into the patient, along with a plasma substitute or donated plasma. Plasmapheresis relieves many of the acute symptoms of WM. Individuals with WM may be given fluid to counter the effects of hyperviscous blood.

Treatments for low blood cell levels include:

• the drug Procrit to treat anemia
• transfusions with packed red blood cells to treat anemia in later stages of the disease
• antibiotics to treat infections caused by a deficiency in white blood cells
• transfusions with blood platelets

Chemotherapy, the use of anti-cancer drugs, helps to slow the abnormal development of plasma cells, but does not cure WM. It can reduce the amount of IgM in the bone marrow. In particular, chemotherapy is used to treat severe hyperviscosity and anemia that are caused by WM.

Chlorambucil (Leukeran), possibly in combination with prednisone, is the typical chemotherapy choice for WM. This treatment is effective in 57% of cases. These drugs are taken by mouth. Prednisone is a corticosteroid that affects many body systems. It has anti-cancer and anti-inflammatory effects and is an immune system suppressant. Other drug combinations that are used to treat WM include cyclophosphamide (Cytoxan), vincristine, and prednisone, with or without doxorubicin. Fludaribine, 2-chlorodeoxyadenosine, and corticosteroids also may be used.

side effects of chemotherapy may include:

• mouth sores
• nausea and indigestion
• hair loss
• increased appetite
• nervousness
• insomnia

These side effects disappear after the chemotherapy is discontinued.

The long-term management of WM usually is accomplished through a combination of plasmapheresis and chemotherapy.

— J. Ricker Polsdorfer; Margaret Alic, Ph.D.