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NCCN Guidelines for Patients



Waldenström’s Macroglobulinemia, Version 1.2017


Cancer treatments


Cycles usually last for several weeks. Chemotherapy

may consist of one or more drugs. When only one

drug is used, it is called a single agent. However, not

all drugs work the same way, so often more than one

drug is used. A combination regimen is the use of two

or more chemotherapy drugs together.

Types of chemotherapy

Alkylating agents and antimetabolites are types of

chemotherapy used to treat WM. Alkylating agents

cause damage to the genetic material in cells.

Antimetabolites disrupt a chemical that helps the cell


A steroid, targeted therapy, or both are often added to

chemotherapy. These treatments are described later in

this chapter. Treatments that combine chemotherapy

with drugs, like rituximab, that affect your immune

system are called chemoimmunotherapy. Rituximab is

a targeted therapy.

Other chemotherapy drugs that are given as the first

(primary) therapy or after the first therapy may be

toxic to stem cells. These drugs include:



Alkylating agents such as bendamustine,

chlorambucil, and cyclophosphamide.

Bendamustine can be given alone or with


Chlorambucil is given alone.

Cyclophosphamide is given with other

chemotherapy agents.

See Guide 6 and

Guide 7.



Antimetabolites such as cladribine and


Cladribine can be given alone or with


Fludarabine can be alone or with rituximab,

or with cyclophosphamide and rituximab.

When treating WM, the effect of the drug on your

body is considered, especially if your doctors are

considering a stem cell transplant as a future

treatment. A stem cell transplant could be a treatment

option for certain people with WM. See page 29 for

more information.

Part 4 is a guide that explains which treatment

options are available for WM. You will learn which

regimens may be part of your treatment plan. You will

learn more about stem cell transplants later in this


Side effects of chemotherapy

A side effect can happen when the cancer treatment

harms the healthy tissue in your body. Chemotherapy

drugs attack fast-dividing cancer cells and can also

damage normal cells that are dividing rapidly. The

reactions to chemotherapy can differ for people with

cancer. Side effects of chemotherapy depend on the

chemotherapy drug given, how much, and how long

you are given the drug. Your health history is also


Some people have many side effects, while others

have few or even none at all. Some side effects can

be very serious while others can be hard to cope

with, but not serious. Most side effects appear when

treatment starts and stop when it is over. However,

other side effects are long-term or may appear years