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Last updated: June 02, 2021
Years published: 1988, 1989, 1990, 1993, 1995, 1997, 1998, 2002, 2006, 2008, 2012, 2015, 2018, 2021
NORD gratefully acknowledges Morie Gertz, MD, Mayo Clinic, for assistance in the preparation of this report.
Waldenström macroglobulinemia (WMG) is a malignant disorder of the bone marrow and lymphatic tissues, a type of lymphoma and characterized by the presence of abnormally large numbers of a particular kind of white blood cell known as B lymphocytes. As these cells accumulate in the body, excessive quantities of an antibody protein known as IgM are produced. Large amounts of IgM cause the blood to become thick (hyperviscosity) and affects the flow of blood through the smaller blood vessels, leading to some of the symptoms of the disorder. Small blood vessels may tear leading to bleeding in the nose, gums, or retina.
Symptoms of Waldenström macroglobulinemia usually begin gradually. Common symptoms are fatigue and loss of energy due to anemia. Bleeding from the nose and gums may also occur, and tingling in the fingers and toes is often seen (peripheral neuropathy). Examination may also reveal enlarged liver, spleen or lymph nodes. Blurring or vision impairment may also occur due to changes in blood flow through the blood vessels that serve the retina. The symptoms are quite variable depending on the effect of the thickened (viscous) blood on the organ involved.
The cause of Waldenström macroglobulinemia is unknown. There is evidence of occurrence within families, but such occurrence is uncommon.
Waldenström macroglobulinemia is a very rare disorder affecting about 1 in 3.4 million American men and about half that number of American women. The incidence of WMG is estimated to be about 5 per 1,000,000 people over the age of 50. The median age at diagnosis is 67. However, patients have been diagnosed in their twenties. This disorder is considerably less common among people of African descent.
When patients show symptoms of an enlarged spleen and liver combined with bleeding of the retina, WMG is reasonably suspected. The results of a complete blood count (CBC) usually show low red blood cell counts as well as low platelet counts. In such circumstances, electrophoresis (analysis of the blood proteins) of serum samples will show a peak reading for IgM. The most common finding preceding the diagnosis is unexplained anemia.
Treatment
With asymptomatic patients, a period of watchful waiting is considered the preferred course. To reduce the blood thickness, plasmapheresis, a method of blood exchange which filters out much of the IgM protein, has been shown to be effective in preventing complications of hyperviscosity. The blood cells are separated from the liquid component (serum or plasma). The heavy IgM molecules that cause the trouble are discarded with the liquid fraction of the exchange. The blood is “reconstituted” by adding previously donated plasma or a plasma substitute. If the disorder progresses, red blood cell transfusions and/or platelet infusions may be necessary.
Traditional chemotherapeutic agents, particularly chlorambucil (Leukeran), cyclophosphamide (Cytoxan) and/or melphalan (Alkeran) either as single agents or in combination with others, have been used in the management of this disease for over 40 years but are not commonly used today. The monoclonal antibody, rituximab, has been found to be effective. Ongoing research is examining combinations of these drugs. Many new therapies have been introduced in the past few years and including bortezomib, Ixazomib, carfilzomib, bendamustine ibrutinib, zanubrutinib and acalbrutinib.
The U.S. Food and Drug Administration (FDA) has approved the use of ibrutinib and zanubrutinib for Waldenstrom macroglobulinemia.
Most people with Waldenström macroglobulinemia have a specific change (mutation) in the MYD88 gene and 30-40% of affected people have a mutation in the CXCR4 gene. These mutations occur in the Waldenstrom cells only and are not inherited. There is some evidence that patients with a CXCR4 mutation are more severely affected and do not respond as well to treatment.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: [email protected]
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/
Peripheral blood stem transplant and bone marrow transplant, using the patient’s own stem cells or marrow and that of related or unrelated donors, has been used but the procedure remains highly controversial.
RareConnect offers a safe patient-hosted online community for patients and caregivers affected by this rare disease. For more information, visit www.rareconnect.org.
TEXTBOOKS
Kipps TJ. Macroglobulinemia. In Lichtman MA, Beutler E, Kipps TJ, Selisohn U, et al. eds. Williams Hematology. 7th ed. New York, NY: McGraw-Hill Companies; 2006:1549-60.
Longo DL, Anderson KC. Plasma cell disorders. In: Kasper, DL, Fauci AS, Longo DL, et al. Eds. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill Companies; 2005:656, 661.
Gertz MA. Waldenström Macroglobulinemia. In: NORD Guide to Rare Disorders. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:37-38.
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1009-1010.
Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:964-65.
JOURNAL ARTICLES
Gertz MA. Waldenström macroglobulinemia: 2021 update on diagnosis, risk stratification, and management. Am J Hematol. 2021 Feb 1;96(2):258-269. doi: 10.1002/ajh.26082. PMID: 33368476.
Castillo JJ, Treon SP. Management of Waldenström macroglobulinemia in 2020. Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):372-379. doi: 10.1182/hematology.2020000121. PMID: 33275726; PMCID: PMC7727571.
Castillo JJ, Morena DF, Arbelaez MI, Hunter ZR and Treon SP. CXCR4 mutations affect presentation and outcomes in patients with Waldenström macroglobulinemia: A systematic review. Expert Rev Hematol.2019 Oct;12(10):873-881. doi: 10.1080/17474086.2019.1649132. Epub 2019 Jul 30.
Gertz MA. Waldenström macroglobulinemia: a review of therapy. Am J Hematol. 2005;79(2):147-57.
Lin P, Medeiros LJ. Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia: an eveolving concept. Adv Anat Pathol. 2005;12:246-55.
Robak T, Korycka A, Kasznicki M, et al. Purine nucleoside analogues for the treatment of hematological malignancies: pharmacology and clinical applications. Curr Cancer Drug Targets. 2005;5:421-44.
Dimopoulos MA, Anagnostopoulos A. Waldenström’s macroglobulinemia. Best Pract Res Clin Haematol. 2005;18:689-707.
Dimopoulos MA, Kyle RA, Anagnostopoulos A, et al. Diagnosis and management of Waldenström’s macroglobulinemia. .J Clin Oncol. 2005;23:1564-77.
Bjorkholm M. Treatment options for Waldenström’s macroglobulinemia. Clin Lymphoma. 2005;5:155-62.
INTERNET
American Cancer Society. Waldenström Macroglobulinemia. https://www.cancer.org/cancer/waldenstrom-macroglobulinemia.html Accessed May 17, 2021.
Macroglobulinemia of Waldenström. Medline Plus. U.S. National Library of Medicine.Review Date 5/31/2020. https://www.nlm.nih.gov/medlineplus/ency/article/000588.htm Accessed May 17, 2021.
NORD and MedicAlert Foundation have teamed up on a new program to provide protection to rare disease patients in emergency situations.
Learn more https://rarediseases.org/patient-assistance-programs/medicalert-assistance-program/Ensuring that patients and caregivers are armed with the tools they need to live their best lives while managing their rare condition is a vital part of NORD’s mission.
Learn more https://rarediseases.org/patient-assistance-programs/rare-disease-educational-support/This first-of-its-kind assistance program is designed for caregivers of a child or adult diagnosed with a rare disorder.
Learn more https://rarediseases.org/patient-assistance-programs/caregiver-respite/The information provided on this page is for informational purposes only. The National Organization for Rare Disorders (NORD) does not endorse the information presented. The content has been gathered in partnership with the MONDO Disease Ontology. Please consult with a healthcare professional for medical advice and treatment.
The Genetic and Rare Diseases Information Center (GARD) has information and resources for patients, caregivers, and families that may be helpful before and after diagnosis of this condition. GARD is a program of the National Center for Advancing Translational Sciences (NCATS), part of the National Institutes of Health (NIH).
View reportOrphanet has a summary about this condition that may include information on the diagnosis, care, and treatment as well as other resources. Some of the information and resources are available in languages other than English. The summary may include medical terms, so we encourage you to share and discuss this information with your doctor. Orphanet is the French National Institute for Health and Medical Research and the Health Programme of the European Union.
View report
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