Chemotherapy for Waldenstrom macroglobulinemia

Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or a muscle, or are taken by mouth. These drugs enter the bloodstream and reach all areas of the body (this is called systemic treatment).

Many types of drugs are useful in treating patients with Waldenstrom macroglobulinemia (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.

Cyclophosphamide is given into an intravenous line. It is rarely used by itself — it usually is given along with other drugs to treat NHL and WM. The combination of cyclophosphamide, adriamycin (hydroxydaunorubicin), vincristine (Oncovin®), and prednisone (called CHOP) is used frequently to treat many types of non-Hodgkin lymphoma (NHL).

Nucleoside analogs

This category includes the drugs pentostatin (Nipent®), fludarabine (Fludara®) and cladribine (Leustatin®). These are given intravenously for several days at a time.

Corticosteroids

This includes the drugs dexamethasone (Decadron), prednisone, methylprednisolone (Solu-medrol®), hydrocortisone, and many others. Corticosteroids are an important part of the treatment of lymphoma, and have been shown to be helpful in treating WM. In addition, these drugs actually help decrease the nausea and vomiting that other chemotherapy 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.

Other

Bortezomib (Velcade®) is a drug that was originally used to treat multiple myeloma but has been found to be helpful in some cases of WM. It belongs to a class of drugs called proteosome inhibitors.

Immunotherapy

This is discussed in the next section.

Chemo side effects

Chemotherapy drugs can also affect some of the normal, healthy cells in your body, causing side effects. Rapidly growing cells, like the blood-producing cells of bone marrow, the cells of hair follicles, and the lining of the digestive tract, are particularly sensitive to chemotherapy.

Chemotherapy side effects 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
• Low blood counts

Chemo can damage the blood-producing cells of the bone marrow, leading to low blood cell counts. This can cause:

• Increased risk of infections (from low white blood cell counts)
• Problems with bleeding or bruising (from low blood platelet counts)
• Fatigue (tiredness) and shortness of breath (from low red blood cell counts)

Other side effects can be seen with certain drugs used to treat WM. For example, bortezomib 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. For more information about chemotherapy and its side effects, please see our document, Understanding Chemotherapy: A Guide for Patients and Families. Most side effects are temporary and go away after treatment is finished. If serious side effects occur, the chemotherapy may have to be reduced or stopped, at least temporarily.

Long-term side effects of chemotherapy

Some chemotherapy drugs cause long-term cell damage directly. This can affect almost any part of the body. One of the most serious late complications of successful chemotherapy is the possibility of developing leukemia. It affects a very small percentage of patients, but it is more common in patients who take fludarabine or alkylating agents.