Waldenström's macroglobulinemia medical therapy: Difference between revisions

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===Hyperviscosity syndrome===
====Hyperviscosity syndrome====
*Waldenström's macroglobulinemia complicated with [[hyperviscosity syndrome]] is a medical emergency and requires prompt treatment with [[plasmapheresis]].<ref name="ADR">Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015</ref>
*Waldenström's macroglobulinemia complicated with [[hyperviscosity syndrome]] is a medical emergency and requires prompt treatment with [[plasmapheresis]].<ref name="ADR">Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015</ref>
*Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes blood thinner.  
*Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes blood thinner.  

Revision as of 06:06, 8 January 2016

Waldenström's macroglobulinemia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]

Overview

Risk stratification determines the protocol of management used for waldenström's macroglobulinemia. There is no treatment for asymptomatic waldenström's macroglobulinemia. The mainstay of treatment for symptomatic waldenström's macroglobulinemia is Rituximab +/- Chemotherapy.[1] Hyperviscosity syndrome is a medical emergency and requires prompt treatment with plasmapheresis.[1]


Medical Therapy

There are several different options for treating waldenström macroglobulinemia depending on stage of the disease.[2]

Asymptomatic/Smoldering Waldenström's Macroglobulinemia

There is no treatment for asymptomatic waldenström's macroglobulinemia.[3] Asymptomatic waldenström's macroglobulinemia can be monitored every 3-6 months - a 'wait and watch approach'.

Symptomatic Waldenström's Macroglobulinemia

Symptomatic patients with waldenström macroglobulinemia are started on chemotherapy depending on the stage.[1]

  • Initial stage of waldenström's macroglobulinemia associated with:

Treatment: Single-agent Rituximab therapy

  • Late stage of waldenström's macroglobulinemia associated with:
  • Adenopathy,
  • Symptomatic splenomegaly,
  • Cytopenias,
  • Hyperviscosity syndrome,
  • Neuropathy, or
  • Constitutional symptoms

Treatment:[1]

Treatment Regimen Drugs Side effects

CHOP-R regimen

Ibrutinib

Rituximab

  • Infusion related reaction
  • Infections

FR regimen

BDR regimen

DRC regimen

CR regimen

  • Cladribine
  • Rituximab

Hyperviscosity syndrome

  • Waldenström's macroglobulinemia complicated with hyperviscosity syndrome is a medical emergency and requires prompt treatment with plasmapheresis.[1]
  • Plasmapheresis temporarily lowers IgM levels by removing some of the abnormal IgM from the blood, which makes blood thinner.
  • Plasmapheresis is usually given until chemotherapy starts to work.
  • Plasmapheresis is combined with chemotherapy to control the disease for a longer period of time.

References

  1. 1.0 1.1 1.2 1.3 1.4 Waldenström's macroglobulinemia: prognosis and management. Blood Cancer Journal (2015)http://www.nature.com/bcj/journal/v5/n3/full/bcj201528a.html Accessed on November 13, 2015
  2. Lymphoplasmacytic lymphoma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/lymphoplasmacytic-lymphoma/?region=ab Accessed on November 6 2015
  3. Waldenström's macroglobulinemia. Patient (2015)http://patient.info/doctor/waldenstroms-macroglobulinaemia-pro Accessed on November 10, 2015

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