NCCN Guidelines for Patients
Waldenström’s Macroglobulinemia, Version 1.2017
lists the first treatment options for WM.
This is called primary treatment. You should get
this treatment if you have symptoms of WM. Some
of the drugs may work better for you than others.
Your doctors have to consider many factors. Thus,
your current health, age, and other health problems
will affect which treatment you receive. If you are
sensitive to any of the drugs, your doctor will start
with a safer treatment for your body. As always, a
clinical trial is a treatment option.
When your treatment is finished, testing will be done
to check treatment results. Imaging tests are used.
For example, a CT of the chest, abdomen, and
pelvis is useful for checking results. Blood samples
are drawn for testing. Your doctor will test your IgM
level. However, treatment is not based on the IgM
level alone. The level can go up or down with certain
drugs. Your doctor will also check if you show any
symptoms or signs of WM. If he or she needs more
information, a biopsy can be done to confirm cancer.
Guide 4. Primary treatment for WM
• Drug – non-stem cell toxic treatment
◦◦ Bortezomib with or without rituximab
◦◦ Bortezomib / dexamethasone
◦◦ Bortezomib / dexamethasone / rituximab
◦◦ Carfilzomab/ rituximab / dexamethasone
◦◦ Cyclophosphamide / doxorubicin / vincristine / prednisone / rituximab
◦◦ Rituximab / cyclophosphamide / predinsone
◦◦ Rituximab / cyclophosphamide / dexamethasone
◦◦ Thalidomide with or without rituximab
• Drug – possible stem cell toxic and/or risk of transformation (or unknown)
◦◦ Bendamustine with or without rituximab
◦◦ Cladribine with or without rituximab
◦◦ Fludarabine with or without rituximab
◦◦ Fludarabine / cyclophosphamide / rituximab
• Clinical trial