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NCCN Guidelines for Patients



Waldenström’s Macroglobulinemia, Version 1.2017


Cancer treatments

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 (




enous). This

transfusion is done to replace blood loss that leads to

low RBC count (anemia).

During plasmapheresis

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.