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37

NCCN Guidelines for Patients

®

:

Waldenström’s Macroglobulinemia, Version 1.2017

4

Treatment guide

Primary treatment

When deciding if you need more treatment, your

doctor will consider your IgM level. He or she will

ask if you have new symptoms, they continue, or get

worse. If you had enlarged lymph nodes or organs

when you were first diagnosed, they will be checked

by physical exam or a CT scan. Sometimes lymph

nodes near the surface of your skin can be felt. Your

next steps will depend on how the first treatment

worked in your body.

Guide 6

lists your next steps based on your disease

response. Once you have your response, your

doctor and you will decide on whether you get more

treatment or not. Next steps may be to wait and

watch for disease to progress, try a drug treatment,

or join a clinical trial. If you are getting a drug

treatment, your doctor will consider what you had the

first time. If you have no response to treatment and

symptoms continue, you will get a different treatment.

If the disease comes back, you might be able to try

the first drug again or try a new drug. It is important

to understand that most people with WM do not enter

a complete remission but can still have a very good

outcome.

Guide 6. Primary treatment response and next steps

Response

Next steps

If disease returns in:

Complete response

ª

• Wait and watch for disease

to progress

ª

• Less than 2 years, start a

different treatment

ª

• Consider rituxumab

ª

• Two or more years, try prior

treatment or start a new one

Very good partial

response

or

Partial respnose

or

Minor response

ª

• Wait and watch for disease

to progress (no symptoms)

ª

• Less than 2 years, start a

different treatment

ª

• Consider rituximab

(no symptoms)

ª

• Two or more years, try prior

treatment or start a new one

ª

• Start a different treatment

(if symptoms keep going)

ª

• Start a different treatment

No response (stable)/

disease progression

ª

• Start a different treatment