|
Most experts recommend that treatment for Waldenstrom
macroglobulinemia should wait until the disease is causing problems.
This lets patients avoid the side effects of chemotherapy until they
really need these medicines. In fact, studies suggest that patients who
start chemotherapy as soon as they are diagnosed do not live any longer
than those who delay treatment until their WM is causing problems.
Doctors agree that hyperviscosity syndrome is a reason for immediate
treatment, as it can be fatal. Other reasons for starting treatment
include problems from amyloidosis and symptoms from cryoglobulinemia,
as well as anemia (low red blood cells), kidney problems, heart
problems, nerve damage, or any severe symptom from the WM.
Once a decision has been made to start chemotherapy, there are
several options. Current guidelines suggest starting treatment with one
of the following:
- an alkylating agent (like chlorambucil or cyclophosphamide)
- a nucleoside analog (like fludarabine or cladribine),
- the monoclonal antibody, rituximab
- the immunomodulating drug thalidomide plus dexamethasone
- bortezomib
A corticosteroid such as dexamethasone or prednisone is often
used along with one of these drugs. These drugs are given in a variety
of combinations and schedules depending on the individual situation.
Some doctors like to use a combination of drugs at the beginning of
treatment. In general, rituximab is not usually given by itself when
the IgM level is very high, because it can make the IgM level
temporarily go up even higher. Also, many experts recommend avoiding
the nucleoside analogs if a stem cell transplant is planned for the
future. Patients should ask their oncologists about schedules that are
effective and convenient to them.
Many different chemotherapy combinations have been used in WM,
including:
- chlorambucil with prednisone
- cyclophosphamide, adriamycin, vincristine, prednisone, and
rituximab (called CHOP-R)
- cyclophosphamide, dexamethasone, and rituximab
- cyclophosphamide and rituximab
- fludarabine and cyclophosphamide
- fludarabine, cyclophosphamide, and rituximab
If a patient has hyperviscosity syndrome or if levels of the
abnormal IgM protein are very high, the doctor may recommend starting
plasmapheresis before chemotherapy. This procedure removes some of the
abnormal IgM from the bloodstream and will lower IgM levels
temporarily. Plasmapheresis does not affect the lymphoma cells that
make the protein, so without a treatment to kill the lymphoma cells
(like chemotherapy or immunotherapy) the IgM protein will just go back
up. Plasmapheresis is usually given to help the patient until the
chemotherapy has a chance to work.
Last Medical Review: 08/04/2009 Last Revised: 08/04/2009
|