Fast Five Quiz: Waldenström Macroglobulinemia Workup

Emmanuel C. Besa, MD


February 01, 2021

Among patients with IgM MGUS, two risk factors have been associated with progression: an abnormal serum free light-chain ratio (ratio of kappa to lambda free light chains) and a high serum M protein level (≥ 1.5 g/dL).

The International Prognostic Index and the Follicular Lymphoma International Prognostic Index are not used to determine prognosis, as WM is a separate lymphoproliferative process with distinct cell surface and genetic characteristics.

Instead, an updated 5-point International Prognostic Score System for WM relies the following criteria:

  • Age: ≤ 65 years, 0 points; 66-75 years, 1 point; ≥ 76 years, 2 points

  • Beta-2 microglobulin > 4 mg/L

  • Lactate dehydrogenase ≥ 250 IU/L (upper limit of normal < 225 IU/L)

  • Serum albumin < 3.5 g/dL

This scoring system is relevant only for patients who require therapy and should not be used to identify patients in need of intervention.

The 6q genetic deletion is present in 42% of patients and is associated with a worse prognosis.

Learn more about the prognosis of WM.

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