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NCCN Guidelines for Patients



Waldenström’s Macroglobulinemia, Version 1.2017


Cancer treatments

Clinical trials

Bone marrow aspiration is used to remove bone

marrow. For this procedure, either regional

anesthesia or general anesthesia will be given. Next,

a needle will be

inserted through the skin into the

hip bone to draw out the bone marrow. The needle

must be inserted many times into one or more spots

to collect enough marrow. The marrow will then be

processed to collect the stem cells.

Collection of the bone marrow takes about 1 hour.

The entire hospital stay will likely be 6 to 8 hours,

which includes recovery time. The aspiration will

likely cause some pain and soreness for a few days.

Anesthesia may cause nausea, headache, and

tiredness. You may need a blood transfusion after the


After apheresis or aspiration, the harvested cells

will be combined with a preservative. Then, they will

be frozen and stored to keep them alive until the

transplant. This process is called cryopreservation.

High-dose chemotherapy

Before the autologous transplant, you will likely

receive high doses of chemotherapy. High doses are

given to kill any cancer cells that may remain after

prior treatment. Chemotherapy is often received for

several days. The transplant will occur 1 or 2 days

later to allow the chemotherapy to clear from your

body. Otherwise, the chemotherapy could damage

the healthy stem cells.

Transplanting stem cells

After chemotherapy, you will receive your healthy

stem cells through a transfusion. A transfusion is a

slow injection of blood products through a central

line into a large vein. A central line (or central venous

catheter) is a thin tube. The tube will be inserted into

your skin through one cut and into your vein through

a second cut. Local anesthesia will be used. This

process can take several hours to complete.

The transplanted stem cells will travel to your bone

marrow and grow. New, healthy blood cells will form.

This is called engraftment. It usually takes about 2


Until then, you will have little or no immune defense.

You may need to stay in the hospital. You may be

given an antibiotic to prevent or treat infection. You

may also be given a blood platelet transfusion to

prevent bleeding and blood transfusion to treat low

red blood counts (anemia). While waiting for the cells

to engraft, you will likely feel tired and weak.

Clinical trials

A clinical trial is a type of research study that people

chose to take part in. Clinical trials help learn how to

prevent, diagnose, and treat a disease like cancer.

Because of clinical trials, doctors find safe and

helpful ways to improve your cancer care. This guide

has many of those tests and treatments that were

found to help people with cancer.

Clinical trials go through levels or phases of testing.

These phases help move the research along to find

out what works best for people with cancer.



Phase I looks at how much and how to give the




Phase II tests for side effects and how it works

on the cancer type.



Phase III compares the new treatment (or new

use of treatment) to what is commonly used.



Phase IV follows late side effects and if the

treatment still works after a long period of time.