Fast Five Quiz: Waldenström Macroglobulinemia Complications

Emmanuel C. Besa, MD


February 01, 2021

About 25% of patients with WM are asymptomatic, and the cancer is often diagnosed incidentally by way of abnormal blood tests. The presence of symptoms does not necessarily dictate whether or not a patient is eligible for therapy. Patients may present with markedly elevated IgM levels and infiltration of the bone marrow in excess of 30%, but if they are asymptomatic, monitoring may be appropriate. On the other hand, patients can have low levels of monoclonal IgM protein and minimal clonal marrow infiltration and still require therapy due to complications associated with the IgM protein (amyloid deposition, cold agglutinin hemolytic anemia, and type II mixed cryoglobulinemia). These complications are a result of the antibody-binding specificity and protein folding of the IgM protein.

Therapy may be indicated for the following complications:

  • Hyperviscosity syndrome

  • Symptomatic cryoglobulinemia

  • Symptomatic cold agglutinin disease

  • Symptomatic adenopathy (enlargement of the lymph nodes) and/or hepatosplenomegaly (simultaneous enlargement of both the liver and the spleen).

IgM MGUS is much more common than WM, and essentially all patients with WM have a preceding phase of IgM monoclonal gammopathy of undetermined significance (MGUS). All patients with IgM MGUS must be monitored.

Although the immunoglobulin free light chain assay is quite valuable in myeloma, its usefulness has not been confirmed in WM and it is not required for monitoring.

Learn more about the workup of WM.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.