Waldenstrom Macroglobulinemia

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Treating Waldenstrom Macroglobulinemia TOPICS

Chemotherapy for Waldenstrom macroglobulinemia

Chemotherapy (chemo) uses anti-cancer drugs that are taken by mouth, or injected into a vein, a muscle, or under the skin. These drugs enter the bloodstream and reach all areas of the body, making this treatment very useful for Waldenstrom macroglobulinemia (WM).

Doctors give chemo in cycles, in which a period of treatment is followed by a rest period to allow the body time to recover. Each chemo cycle generally lasts for several weeks. Most chemo treatments are given on an outpatient basis (in the doctor’s office or clinic or hospital outpatient department).

Many types of chemo drugs can be used to treat patients with WM. They may be used alone or combined with other drugs or treatments.

Alkylating agents

This class of chemotherapy drugs includes chlorambucil (Leukeran®), cyclophosphamide (Cytoxan®), and bendamustine (Treanda®).

Chlorambucil is a pill, and is usually given with a drug called prednisone, which is a corticosteroid (see below).

Cyclophosphamide and bendamustine are given into an intravenous (IV) line. These drugs are usually given along with other drugs to treat non-Hodgkin lymphoma (NHL) and WM. For example, the combination known as CHOP-R, which consists of cyclophosphamide, Adriamycin® (hydroxydaunorubicin), vincristine (Oncovin®), prednisone, and the immunotherapy drug rituximab (Rituxan®), can be used to treat many types of NHL, including WM.

Nucleoside analogs

This category includes the drugs fludarabine (Fludara®) and cladribine (Leustatin®). These drugs are given intravenously (IV) over several days, usually along with other drugs such as the immunotherapy drug rituximab.


Corticosteroid drugs such as dexamethasone (Decadron), prednisone, methylprednisolone (Solu-medrol®), hydrocortisone, and many others are an important part of the treatment of lymphoma, and have been shown to be helpful in treating WM. These drugs have an added benefit in that they can also help decrease the nausea and vomiting that other chemotherapy drugs may cause.

These drugs can cause other side effects, including problems sleeping and an increased appetite. These symptoms go away after the drug is stopped.

Proteasome inhibitors

These drugs work by stopping enzyme complexes (proteasomes) in cells from breaking down proteins that help keep cell division under control. Although these drugs work in a slightly different way from most chemotherapy drugs, they can still cause many of the same types of side effects (see below).

Bortezomib (Velcade®) is a drug that is often used to treat multiple myeloma and some types of lymphoma. It has been found to be helpful in some cases of WM. It is given as an infusion into a vein (IV) or an injection under the skin (sub-q).

Carfilzomib (KyprolisTM) is a newer drug used to treat multiple myeloma. Studies are now looking at whether it can help treat WM as well. It is given as an infusion into a vein (IV).

mTOR inhibitors

These drugs also work slightly differently from most chemo drugs. They block a cell protein known as mTOR, which normally helps cells grow and divide into new cells.

Everolimus (Afinitor®) is used more often to treat kidney cancer, but it has also been shown to be useful in treating WM after other treatments have been tried. This drug is taken daily as a pill. Common side effects include fatigue (tiredness), mouth pain, rash, diarrhea, and infections.

Chemo side effects

Chemo drugs attack cells that are dividing quickly, which is why they work against WM cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to certain side effects.

The side effects of chemo depend on which drugs are used, as well as the amount taken, and the length of time they are taken. Common side effects include:

  • Nausea and vomiting
  • Loss of appetite
  • Temporary loss of hair
  • Mouth sores
  • Diarrhea or constipation
  • Increased risk of infections (from too few white blood cells)
  • Problems with bleeding or bruising (from too few blood platelets)
  • Fatigue (tiredness) and shortness of breath (from too few red blood cells)

Other side effects can be seen with certain drugs. For example, proteasome inhibitors can damage nerves, causing pain in the feet and legs. The nerve damage usually gets better after the drug is stopped, but it may not go away completely. Fludarabine suppresses the immune system, making patients more likely to get certain serious infections.

If you have side effects, your cancer care team can suggest steps to ease them. For example, there are very good medicines that help prevent and control nausea and vomiting. Most side effects are temporary and go away after treatment is finished. If you have serious side effects, the chemotherapy may have to be reduced or stopped, at least temporarily.

Long-term side effects of chemotherapy

Some chemotherapy drugs cause long-term side effects that can affect almost any part of the body. One of the most serious complications of chemotherapy is the possibility of developing leukemia later on. It affects a very small percentage of patients, but it is more common in patients who take fludarabine or alkylating agents.

For more information about chemotherapy and its side effects, please see the “Chemotherapy” section of our website, or our document Understanding Chemotherapy: A Guide for Patients and Families.

Last Medical Review: 06/19/2013
Last Revised: 06/19/2013