Waldenström's macroglobulinemia(patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Macroglobulinemia of Waldenstrom is a cancer of the B lymphocytes (a type of white blood cell). It is associated with the overproduction of proteins called IgM antibodies.

What are the symptoms of Waldenström's macroglobulinemia?

• Bleeding of the gums
• Blurred or decreased vision
• Dizziness
• Easy bruising of the skin
• Fatigue
• Headache
• Mental status changes
• Nosebleeds
• Numbness, tingling, or burning pain in the hands, feet, fingers, toes, ears, or nose
• Rash
• Unintentional weight loss
• Vision loss in one eye

Additional symptoms that may be associated with this disease:

• Bluish skin discoloration
• Fingers that change color upon pressure
• Flank pain
• Swollen glands

What causes Waldenström's macroglobulinemia?

Waldenstrom's macroglobulinemia is a result of a condition called lymphoplasmacytic lymphoma. The cause of the overproduction of the IgM antibody is unknown, but researchers believe it is made by lymphoma cells.

Overproduction of IgM causes the blood to become too thick. This is called hyperviscosity. It occasionally makes it harder for blood to flow through small blood vessels.

About 1,500 people in the United States are diagnosed with Waldenstrom's macroglobulinemia every year. Most people with this condition are over age 65, however, it may occur in younger people.

Diagnosis

Signs may include:

• Swollen/enlarged spleen
• Swollen/enlarged liver
• Swollen/enlarged lymph nodes
• An eye exam may show enlarged veins in the retina or retinal bleeding(hemorrhages).

Tests may include:

• Complete blood count (CBC) - shows a low number of red blood cells and platelets
• Blood chemistry - evidence of kidney disease
• Serum viscosity test
• Serum protein electrophoresis - increased amount of the IgM antibody. Levels seen in Waldenstrom's macroglobulinemia are generally greater than 3 g/dL.
• Bone marrow examination - show cells that resemble both lymphocytes and plasma cells

Additional tests that may be done:

• 24-hour urine protein
• Total protein
• Serum globulin electrophoresis
• Immunofixation in urine
• T (thymus derived) lymphocyte count

When to seek urgent medical care?

Call your health care provider if any symptoms of this disorder develop.

Treatment

• Plasmapheresis - removes unwanted substances from the blood. In macroglobulinemia, it removes or reduces the high level of IgM, and is used to quickly control the symptoms caused by blood thickening.

• Drug therapy - may include steroids, Leukeran, Alkeran, Cytoxan, fludarabine, or rituximab, or combinations of chemotherapy drugs.

• Patients who have a low number of red or white blood cells or platelets may need transfusions or antibiotics.

What to expect (Outlook/Prognosis)?

The average survival is about 6.5 years. Some people live more than 10 years.

In some people, the disorder may produce few symptoms and progress slowly.

Possible complications

• Changes in mental function, possibly leading to coma
• Congestive heart failure
• Gastrointestinal bleeding
• Vision problems