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NCCN Guidelines for Patients



Waldenström’s Macroglobulinemia, Version 1.2017


Treatment guide

Primary treatment

Guide 4

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

Primary treatment

• Drug – non-stem cell toxic treatment

◦◦ Bortezomib with or without rituximab

◦◦ Bortezomib / dexamethasone

◦◦ Bortezomib / dexamethasone / rituximab

◦◦ Carfilzomab/ rituximab / dexamethasone

◦◦ Cyclophosphamide / doxorubicin / vincristine / prednisone / rituximab

◦◦ Ibrutinib

◦◦ 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

◦◦ Chlorambucil

◦◦ Fludarabine with or without rituximab

◦◦ Fludarabine / cyclophosphamide / rituximab

• Clinical trial