Waldenstrom macroglobulinemia

Waldenstrom macroglobulinemia is an indolent (slow-growing) type of B-cell non-Hodgkin lymphoma (NHL). It may also be called lymphoplasmacytic lymphoma. It often affects the bone marrow, lymph nodes and spleen. It can also cause nerve damage (called peripheral neuropathy). Waldenstrom macroglobulinemia can sometimes change into an aggressive (fast-growing) type of NHL.

People with Waldenstrom macroglobulinemia have a high amount of immunoglobulin M (IgM) or M-protein in the blood. This can cause a condition called hyperviscosity syndrome. People with hyperviscosity syndrome have thicker blood than normal and can have bleeding problems, vision problems and nervous system problems.

You may be offered the following treatments for Waldenstrom macroglobulinemia. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

If Waldenstrom macroglobulinemia is developing slowly and not causing symptoms, you may be offered watchful waiting. The healthcare team will use tests to closely monitor the lymphoma. When symptoms appear or there are signs that the disease is progressing more quickly, they will offer other treatments.

Find out more about watchful waiting for NHL.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Targeted therapy may also be called molecular targeted therapy.

A single targeted therapy drug or a combination of drugs may be used. Targeted therapy may be used alone or with chemotherapy.

Targeted therapy drugs used to treat Waldenstrom macroglobulinemia include:

• rituximab (Rituxan and biosimilars)
• ibrutinib (Imbruvica)
• acalabrutinib (Calquence)
• zanubrutinib (Brukinsa)
• bortezomib (Velcade)
• lenalidomide (Revlimid)

These targeted therapy drugs may not be covered by all provincial or territorial health plans.

Find out more about targeted therapy for NHL.

Chemotherapy uses drugs to destroy cancer cells. The drugs that may be used for Waldenstrom macroglobulinemia include:

• bendamustine (Treanda, Benvyon, Esamuze)
• fludarabine (Fludara)
• cyclophosphamide (Procytox)
• chlorambucil (Leukeran)
• cladribine

Targeted therapy drugs or immunotherapy drugs may be used along with chemotherapy drugs. Corticosteroids, such as dexamethasone or prednisone, may also be given.

Combinations of drugs that may be used to treat Waldenstrom macroglobulinemia include:

• BR – bendamustine and rituximab
• DRC – cyclophosphamide, dexamethasone and rituximab
• bortezomib and rituximab, with or without dexamethasone
• CVP – cyclophosphamide, vincristine and prednisone
• R-CVP – rituximab, cyclophosphamide, vincristine and prednisone
• thalidomide (Thalomid) and rituximab
• CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone

Find out more about chemotherapy for NHL.

Plasma exchange (also called plasmapheresis) involves removing plasma from the blood and replacing it with a substitute. Plasma exchange can be used to treat hyperviscosity syndrome.

A stem cell transplant replaces stem cells. If you are healthy enough, you may be offered a stem cell transplant for Waldenstrom macroglobulinemia that comes back (relapses) after treatment or doesn’t respond to other treatments (called refractory disease).

Find out more about stem cell transplant for NHL.

Talk to your doctor about clinical trials open to people with NHL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.