Find out what your next steps should be in planning your patient’s treatment
Patients with low Hb levels, high lymphoplasmacytic cell infiltration, IgM flare and high ß2-microglobulin levels may be at higher risk for development of symptomatic WM.
However, patients may be asymptomatic for 5–10 years and can be managed with a ‘watch and wait’ approach, without treatment and should be followed up every 3-6 months.
No data exist to support early initiation of therapy over a watch and wait strategy, nor is the level of monoclonal IgM alone an indication to start treatment.
Hyperviscosity is a clinical emergency. Plasmapheresis should be used immediately in patients with symptomatic hyperviscosity, in addition to appropriate systemic therapy for WM.
Additional work-up is often based on symptomatic presentation and laboratory findings that can indicate the need for treatment initiation.
Anaemia with haemolysis
• Coombs testing
Raynaud-like symptoms, acrocyanosis, ulcerations
• Fat aspirate stained with Congo red
Patients are monitored every 3–6 months after finishing treatment, possibly requiring further tests to assess their disease state. If they relapse from WM remission, depending on the response to their first-line treatment, this could be repeated, or they can be put in a second-line of treatment.
CAR T-cell=chimeric antigen receptor T-cell; ESMO=European Society for Medical Oncology; IgM=immunoglobulin M; Hb=haemoglobin; WM=Waldenström’s macroglobulinemia.
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