How is hyperviscosity syndrome treated in Waldenstrom macroglobulinemia (WM)?

Updated: Aug 06, 2020
  • Author: Joseph M Tuscano, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Hyperviscosity syndrome should be suspected in patients with WM/LPL who have a serum viscosity greater than 4 units (Centipoises [cp]). [17]

Urgent plasmapheresis followed by initiation of systemic chemotherapy (see Table 1, above) is an accepted treatment approach for symptomatic hyperviscosity. Two to three exchanges are required to reduce the IgM levels by 30%-60%. Rituximab is known to precipitate a flare reaction and should either be administered after plasmapheresis or omitted from the first cycle of therapy in at-risk patients. [18]

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