[<< wikibooks] Radiation Oncology/Waldenstroms
Waldenstrom's Macroglobulinemia

B-cell proliferative disorder with bone marrow lymphoplasmacytic infiltration and production of monoclonal IgM; considered to be a low-grade lymphoma
Symptoms are usually due to blood hyperviscosity, anemia, and hepatosplenomegaly
Asymptomatic patients are typically observed
Alkylating agents (chlorambucil), nucleoside analogues, and rituximab (eg CHOP-R) are reasonable first line approaches
Symptomatic support as necessary
For RT treatment of splenomegaly, please see the Spleen chapter
Historically, hemibody and total body irradiation was used, but it has fallen out of favor with development of more modern chemotherapies
Italy; 2002 PMID 12187029 -- "Advanced waldenström's macroglobulinemia: a case of possible cure after systemic chemotherapy, splenic radiation and splenectomy." (Cavanna L, Acta Haematol. 2002;108(2):97-101.)
Case report. 41M with WM, massive splenomegaly. Treated with plasmaparesis, chemo (BCNU, cyclophosphamide, vincristine, melphalan, prednisone) x16 cycles, and splenic RT 36 Gy
Outcome: Persistent mild splenomegaly and small IgM band. He then underwent splenectomy, showing persistent disease. 2 months later, complete response, and has remained disease-free x18 years
Conclusion: Splenectomy should be considered; spleen RT 36 Gy with chemo didn't seem sufficient to fully eradicate the diseaseJapan; 1997 PMID 9322902 -- "Durable remission after splenectomy for Waldenström's macroglobulinemia with massive splenomegaly in leukemic phase." (Takemori N, Leuk Lymphoma. 1997 Jul;26(3-4):387-93.)
Case report. Patient with WM and massive splenomegaly, refractory to chemo. Splenic RT effectively reduced serum IgM, spleen size, and lymphocyte counts, however, only transient
He then underwent splenectomy, and has been in remission for 6 years
Conclusion: Recommend splenectomy as part of management1977 PMID 405054 -- "Report of a case of Waldenström macroglobulinemia treated and controlled by radiotherapy." (Shehata WM, Blood. 1977 Jun;49(6):1023-4.)
Case report
Review; 2007 PMID 17634838 -- "Treatment of Waldenstrom's Macroglobulinemia." (Dimopoulos MA, Curr Treat Options Oncol. 2007 Apr;8(2):144-53.)