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Waldenstrom Macroglobulinemia: Symptoms and Treatment

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Published on January 15, 2020

Key Takeaways

  • Hyperviscosity syndrome requires urgent treatment.
  • There are many different Waldenstrom treatment options for patients who show symptoms.
  • Treatment strategies for Waldenstrom macroglobulinemia are personalized and vary by symptoms and which side effects a patient is willing to risk.

Regarding Waldenstrom macroglobulinema treatment, Dr. Larry Anderson shares, “It’s really a personalized decision between the patient and the doctor,” as he explains that treating Waldenstrom is not a one-size-fits-all approach. Dr. Anderson, an expert from UT Southwestern Medical Center, joined Patient Power at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition to explain the symptoms of Waldenstrom and to share what treatment options are currently available. Dr. Anderson also talks about what factors a patient should consider when discussing a potential treatment plan with their doctor. Watch now to learn more from a Waldenstrom expert.

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Transcript | Waldenstrom Macroglobulinemia: Symptoms and Treatment

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Dr. Anderson:

Some patients with Waldenstrom's may have smoldering disease that's sort of like a precancer where they have detectable disease in the bone marrow, they have an elevated IgM but no symptoms.  And the symptoms that we look for that would require treatment would be anemia, large spleen, something called hyperviscosity.  Because this IgM protein is very large, it's five times larger than the normal immunoglobulins from myeloma, for example, and so with the same amount of disease they can have five times more protein levels circulating in their blood, and that high level of protein can cause sludging of the blood, and those patients may have blurry vision or nosebleeds or dizziness.  That's called hyperviscosity and that would require urgent treatment. 

The patients that have symptoms, we have many different treatment options.  If they have just low‑level symptoms like anemia and they don't have hyperviscosity, then a lot of times we'll treat them with a monoclonal antibody called rituximab (Rituxan) that targets CD20 on the lymphoplasmacytic cells.  If they have more urgent symptoms and need urgent treatment, then we will often combine that with something else. 

And also something to be watching out for is when we use rituximab alone in Waldenstrom's patients we can see a flare of the IgM in about half of those patients.  So if they have really high levels of IgM at baseline, we don't start out with rituximab therapy.  We have to sort of bring those levels down with other treatments.  One of the main recommended treatments would be a chemotherapy called bendamustine (Treanda), and then after a cycle or two, once we get those IgM levels down, we'll combine that with the rituximab antibody therapy. 

For those patients that don't want chemotherapy like bendamustine, we have several other options actually.  We have an oral drug called ibrutinib (Imbruvica) that is a daily pill that the patient would take.  And we have an injection of a proteasome inhibitor, bortezomib (Velcade).  We have basically several different options and combinations and every patient—it's really a personalized decision between the patient and the doctor as to how much symptoms they're having, what side effects they're willing to risk, what they're not willing to risk. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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