Internal Medicine

0521779407-23 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:24

1548 Waldenstrom’s Macroglobulinemia

WALDENSTROM’S MACROGLOBULINEMIA

KENNETH C. ANDERSON, MD

history & physical

■Symptomatic anemia and hyperviscosity

■Adenopathy and organomegaly

tests

Basic Blood Studies

■Anemia, leukopenia, thrombocytopenia, renal insufficiency, quan-

titative monoclonal protein, hepatitis, elevated serum viscosity

Specific Diagnostic Tests

■Excess monoclonal lymphoplasmacytoid cells in bone marrow

■Computerized tomographic scan of chest/abdomen/pelvis to

demonstrate organomegaly/adenopathy

■Cold agglutinins, cryocrit

■Hepatitis serology

differential diagnosis

■Monoclonal gammopathy of unknown significance: low level IgM

without any other manifestations of Waldenstrom’s macroglobuline-

mia

■Non-Hodgkin’s lymphoma: distinct histopathology

■Chronic lymphocytic leukemia: circulating mature lymphocytes

■Primary amyloidosis: plasma cells in marrow, distinct viscera in-

volved

■Other lymphoproliferative disorders: distinct histopathology

management

What to Do First

■Plasmapheresis for sympomatic hyperviscosity

specific therapy

Indications

■Symptomatic hyperviscosity

■Anemia, pancytopenia

■Bulky adenopathy or symptomatic organomegaly

■Symptomatic cryoglobulinemia or neuropathy

Treatment Options

■Alkylating agents: high response rates, but compromise stem cell

reserve; dysmyelopoiesis with prolonged use