What are the recommended medication protocols for the treatment of Waldenström macroglobulinemia?

Updated: May 29, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Because the paucity of high-quality data on WM treatment, Mayo Stratification of Macroglobulinemia and Risk-Adapted Therapy (mSMART) guidelines, issued in 2016, advocate participation in clinical trials. Outside of trials, mSMART guidelines recommend a single cycle of rituximab (with no maintenance therapy) for patients with any of the following [4] :

  • Hemoglobin < 11 g/dLor symptomatic
  • Platelet count < 120 x 10 9/L
  • IgM-related neuropathy
  • WM-associated hemolytic anemia
  • Symptomatic cryoglobulinemia

For patients with bulky disease, profound cytopenia (hemoglobin ≤ 10 g/dL, platelets < 100 x 109/L), constitutional symptoms, or hyperviscosity symptoms, mSMART guidelines recommend four to six cycles of bendamustine plus rituximab, preceded by plasmapheresis in patients with symptomatic hyperviscosity. An alternative, particularly for patients with nonbulky WM, is dexamethasone plus rituximab and cyclophosphamide. After entering remission, patients aged 70 years or younger who are potential candidates for autologous stem cell transplantation may be considered for stem cell harvest for future use.

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