Find out what your next steps should be in planning your patient’s treatment
From the first description in 1944 by the Swedish hematologist Jan Waldenström, to the evolutions in management and treatment, with a look to possible future developments.
CP-299792, approved on 11/05/2022
These clinical symptoms are indications treatment should be initiated in your patient:
If your patient displays the following laboratory findings, treatment should be initiated:
The ESMO guidelines for the management of WM outline clinical and laboratory indications for treatment initation.
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
For asymptomatic patients with acceptable IgM blood levels, no treatment is required. These patients will be monitored and seen by their clinic every 3–6 months for review.
This course of action may seem confusing at first, but as there is no evidence that treating early in asymptomatic patients is beneficial, ‘watch and wait’ is applied in order to maintain the patient’s quality of life.
Treatment will begin if the patient:
Treatment may be required to treat WM symptoms and side effects of WM treatment, which include:
There are a range of different treatment options for WM patients[^6]:
Treatment selection should then be directed by the overall health of your patient, tumour burden, and clinical presentation. Guideline therapy recommendations should be considered in conjunction with local practices and available treatment options.
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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