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If the level of abnormal IgM protein in the blood gets very high in a patient with Waldenstrom macroglobulinemia (WM), the blood becomes very thick (viscous). This is called hyperviscosity syndrome and can lead to brain damage (like a stroke) and bleeding problems. When this happens, the level of IgM needs to be lowered right away.
Plasmapheresis (also known as plasma exchange) uses a machine to separate the plasma (the liquid part of blood) that contains the abnormal IgM protein from the blood cells. The plasma containing the abnormal protein is discarded, while the blood cells are mixed with salt solution and plasma from a donor and given back to the patient.
Plasmapheresis is done over a few hours while the person lies in a bed or sits in a reclining chair. The blood is removed through an IV line (usually in a vein in the arm), goes through the machine where the plasma is replaced, and then is returned to the body through another IV line. Sometimes, minor surgery is done before the procedure to put a single large catheter in a large vein just below the neck or under the collar bone instead of using IV lines in the arms. This type of catheter, called a central line or central venous catheter (CVC), has both IVs built in.
Plasmapheresis is not painful (aside from the IV lines being put in), but it can be hard to stay sitting or lying down in the same place for 2 or 3 hours. Calcium levels can drop in some people during treatment, causing numbness and tingling (especially in the hands and feet and around the mouth) and muscle spasms, which can sometimes be painful. This can be treated by giving the patient calcium.
Plasmapheresis works quickly to bring down the IgM level. However, it does not treat the cause of the high IgM level (the cancer cells themselves), so it will go back up again without further treatment (like chemotherapy). Plasmapheresis is usually given to help the patient until chemotherapy or other drugs have a chance to work. It can also be used in people whose WM is not controlled by other treatments.
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Buske C, Leblond V, Dimopoulos M, et al. Waldenstrom’s macroglobulinaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi155–159.
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Mazzucchelli M., Frustaci A.M., Deodato M., Cairoli R., Tedeschi A. Waldenstrom’s macroglobulinemia: an update. Mediterr J Hematol Infect Dis 2018, 10(1): e2018004, DOI: http://dx.doi.org/10.4084/MJHID.2018.004
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Waldenstrom’s macroglobulinemia/Lymphoplasmacytic lymphoma. V.1.2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/waldenstroms.pdf on June 21, 2018.
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Last Revised: July 19, 2018