Waldenström Macroglobulinemia

Waldenström Macroglobulinemia
Waldenström Macroglobulinemia

Overview Of Waldenström Macroglobulinemia

Waldenström Macroglobulinemia is a cancer of the B lymphocytes (a type of white blood cell). Waldenström Macroglobulinemia (WM) is associated with the overproduction of IgM antibody proteins.

Commonly Associated With

Macroglobulinemia – primary; Lymphoplasmacytic lymphoma; Monoclonal macroglobulinemia

Causes Of Waldenström Macroglobulinemia

WM is a result of a condition known as lymphoplasmacytic lymphoma. This is a cancer of the white blood cells, in which the B immune cells start dividing quite rapidly. The exact cause of too much production of the IgM antibody is unknown. Hepatitis C may increase the risk of WM. It is generally common to find gene mutations in malignant B cells.

Production of excess IgM antibodies can cause many problems including:

  • Hyperviscosity, because it causes the blood to become too thick. This can make it more difficult for blood to flow through small blood vessels.
  • Nerve damage, or neuropathy, when the IgM antibody reacts with nerve tissue.
  • Anemia, when IgM antibodies bind to red blood cells.
  • Kidney disease, when the IgM antibodies deposit in kidney tissue.
  • Cryoglobulinemia and vasculitis; when the IgM antibody forms immune complexes with cold exposure.
  • Waldenström Macroglobulinemia is very rare. Most people with this condition are over the age of 65.

Symptoms Of Waldenström Macroglobulinemia

Symptoms of WM may include any of the following:

  • Bleeding of the gums as well as nosebleeds
  • Blurred or decreased vision
  • Blue colored skin in the fingers after cold exposure
  • Dizziness or confusion
  • Easy bruising of the skin
  • Fatigue
  • Diarrhea
  • Numbness, tingling, or burning pain in the hands, feet, fingers, toes, ears, or nose
  • Rash
  • Swollen glands
  • Unintentional weight loss
  • Vision loss in one eye

Exams & Tests

A physical examination may show a swollen spleen, liver, and lymph nodes. An eye exam may also reveal enlarged veins in the retina or retinal bleeding (hemorrhages).

A complete blood count (CBC) shows a low number of both red blood cells and platelets. Blood chemistry may show evidence of kidney disease. A test called serum protein electrophoresis will also show an increased level of IgM antibodies. Levels are often higher than 3000 mg/L. An immunofixation test will be completed to show that IgM antibodies are derived from a single cell type.

A serum viscosity test can identify if the blood has become thick. Symptoms typically occur when the blood is four times thicker than normal. A bone marrow biopsy will show an increased number of abnormal cells that look like lymphocytes and also plasma cells.

Additional tests may also include:

  • 24-hour urine protein
  • Total protein
  • Immunofixation in urine
  • T (thymus-derived) lymphocyte count
  • Bone x-rays

Treatment Of Waldenström Macroglobulinemia

Occasionally, people with Waldenström Macroglobulinemia who have increased IgM antibodies don’t have symptoms. This condition is known as smoldering WM. No treatment is needed other than careful follow-up.

In individuals with symptoms, treatment generally aims to decrease symptoms and the risk of developing organ damage. There is no current standard treatment. Your health care provider may suggest participation in a clinical trial. Plasmapheresis removes the IgM antibody from the blood. It also quickly controls the symptoms caused by the blood thickening.

Medicines may include corticosteroids, a combination of chemotherapy medicines, and the monoclonal antibody to B cells (rituximab). Autologous stem cell transplant might be recommended for certain people with otherwise good health. People who have a low number of red blood cells, white blood cells, or platelets may need transfusions or antibiotics.