Immunotherapy for Waldenstrom Macroglobulinemia

Some immunotherapy drugs are used to treat Waldenstrom macroglobulinemia (WM). Immunotherapy is the use of medicines to help a person’s own immune system recognize and destroy cancer cells.

Monoclonal antibodies to treat WM

Antibodies are proteins made by your immune system to help fight infections. Man-made versions of these proteins are called monoclonal antibodies. They can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which Waldenstrom macroglobulinemia starts).

Monoclonal antibodies that attack CD20

Some monoclonal antibodies attack a protein called CD20 found on the surface of lymphocytes, including the WM cells. These drugs tell the lymphoma cell to die.

These drugs include:

• Rituximab (Rituxan)
• Obinutuzumab (Gazyva)

These drugs are given by infusion into a vein (IV) at the doctor’s office or clinic. They can be given alone or with chemotherapy or targeted therapy as part of treatment.

These drugs must be given carefully to people with Waldenstrom macroglobulinemia, because sometimes they actually raise the level of IgM in the blood at first, which can lead to problems with hyperviscosity (thickened blood).

Side effects during the infusion are common. These can include chills, fever, nausea, rashes, fatigue, and headaches. Unlike regular chemotherapy, rituximab doesn’t cause low blood counts or hair loss.

Monoclonal antibodies that attack CD38

Daratumumab is another drug used to treat WM. This monoclonal antibody attacks the cell-surface protein CD38 on lymphocytes. It may be used in combination with other chemo or targeted drugs.

Immunomodulating drugs to treat WM

Immunomodulating drugs are thought to work by boosting the immune system, but the exact way they work is not fully understood. 

They include:

• Lenalidomide
• Pomalidomide

These drugs may be tried as a treatment for Waldenstrom macroglobulinemia when other treatments haven’t worked.

Possible side effects include low blood counts and neuropathy (injury to the nerves causing difficulty moving or pain). Your cancer care team will monitor you closely for these side effects.

These drugs can also cause birth defects and should not be taken during pregnancy.