NCCN Guidelines for Patients
Waldenström’s Macroglobulinemia, Version 1.2017
Plasmapheresis | Chemotherapy
Treatment is given to people with WM who
have symptoms. It is helpful to learn about
treatment. Ask your doctor what your
treatment options are. Part 3 will introduce
you to different treatment types for WM.
You will also learn how the cancer drugs
work in your body.
Plasmapheresis is a process that removes IgM
from the blood. It can be given first, before cancer
treatment, if you have symptoms of hyperviscosity.
Hyperviscosity should be treated as soon as
possible to temporarily remove the abnormal IgM in
your blood. This can rapidly relieve symptoms. For
example, people with peripheral neuropathy that is
worsening, or ulcers that are not healing, may need
plasmapheresis. Plasmapheresis is sometimes
performed once or twice soon after diagnosis.
However, it may be recommended that you continue
weekly or monthly treatments for a period of time.
Plasmapheresis lowers IgM in your blood so you can
feel better. You may have fewer symptoms that can
come on suddenly from your chemotherapy drugs.
For example, it can be done before you receive
treatment with rituximab. The process itself does
not stop the cancer from growing. It is more of a
treatment to prepare you for cancer-fighting drugs
like chemotherapy. You might need an RBC (
ell) transfusion after plasmapheresis. Blood
is given to you through an IV (
transfusion is done to replace blood loss that leads to
low RBC count (anemia).
During the process, the plasma is removed from
the blood. Plasma is the liquid part of the blood that
contains IgM. This plasma needs to be replaced.
An IV is put into a vein to remove the plasma and
replace it with donor plasma. A salt solution and
plasma from a donor is put back into your blood.
This treatment can be 2 to 3 hours long. During
this process, you are seated in a reclining chair or
asked to lie down on a table. Most of the time the
IV is put into a vein in your arm. For some people, a
catheter may need to be inserted. A catheter is a thin,
long tube that is often placed in the chest. This thin
tube goes into a large vein and can stay in after the
treatment and be used again, if needed.
Chemotherapy, or chemo, is a main systemic cancer
treatment. Systemic treatment travels throughout
the body to treat or control areas of cancer.
Chemotherapy includes drugs that disrupt the life
cycle of cancer cells. Some damage DNA directly;
others get in the way of processes that help cancer
cells build DNA.
Some chemotherapy drugs work when cells are in
an active growth phase. During the active growth
phase, cells grow and divide to form a new cell.
Chemotherapy drugs that disrupt the growth phase
work well for cancer cells that are growing and
dividing quickly. Other chemotherapy drugs work
whether cells are in a growth or resting phase.
Chemotherapy can affect both cancer and normal
This kind of treatment can be given in many ways.
Most chemotherapy drugs for WM are given as
liquids that are slowly injected into a vein by an
IV. Some are a pill that is swallowed. Either way,
chemotherapy is given in cycles of treatment days
usually followed by days of rest. This allows your
body to recover before the next cycle.