NCCN Guidelines for Patients
Waldenström’s Macroglobulinemia, Version 1.2017
Testing for WM
If needed, a small sample of tissue from a lymph
node or organ is removed by incisional biopsy,
core biopsy, or FNA (
uses a thin needle with a syringe to take a sample
of suspicious tissue. The entire lymph node or
abnormal mass of cells (tumor) can be removed
during an excisional biopsy to check for cancer.
Other lymphomas are usually diagnosed this way.
MYD88 (L265P) test
DNA is a chain of chemicals inside cells that contains
coded instructions for making and controlling cells.
Your DNA contains instructions from genes that tell
your cells how to grow and behave. When bone
marrow or other tissue is tested, a lab technician
can look at the DNA to see if there is any specific
mutation (change) with a diagnosis of WM. This
mutation is called MYD88 (L265P). This mutation
is common for this cancer. It is found in more than
90 out of 100 people with WM. It may be helpful in
determining the diagnosis of WM from other cancers
that look like WM. Doctors can also determine if
someone will benefit from a getting a cancer drug
known as ibrutinib.
More than 40 types of CXCR4 mutations can be
found in people with WM. CXCR4 mutations are
found in 30–40 out of 100 people with WM. It may
help doctors understand if and when people will
respond to ibrutinib therapy.
The biopsy samples will be sent to a pathologist. A
pathologist is a doctor who’s an expert in examining
cells to find disease. For WM, a hematopathologist
may test for cancer. Hematopathologists are
pathologists who specialize in testing for disease of
the blood and lymph nodes. The hematopathologist
will examine the samples using a microscope to see
which type of cancer it is. He or she will look at the
size, shape, type, and specific features of the cells.
The results of the tests, including those described
next, will be recorded in a pathology report. It may
take a few days to get a copy. It’s a good idea to
keep a copy of your pathology report. Your doctors
will use the results to plan your treatment.
For diagnosis, the hematopathologist needs to study
the proteins on the cells’ surface The surface is
called the cell membrane. This technique is called
immunophenotyping. WM has a common pattern or
“signature” of proteins. These proteins the doctor
checks for are sIgM+, CD19+, and CD20+. A small
number of people with WM express CD5, CD10, and
Ways to test for these proteins are:
(antigens) on the surface of cells to identify the
type of cells present. Blood or bone marrow will
be passed through a flow cytometry machine.
It uses a dye that reacts to light when checking
for the substances.
uses a chemical
to find specific cell traits involved in abnormal
Other tests can be done before treatment. This
depends on what your doctor decides is necessary.
He or she can do certain tests because of treatment
they plan to give you.
Your symptoms are also considered before
ordering a test. More tests will be done if your
hands or feet react poorly to colder temperatures
(cryoglobulinemia) or show signs of nerve
problems (neuropathy). Symptoms like this will
alert your doctor to test for cryoglobulins or do an
electromyogram to check what nerves have been