title: Waldenström macroglobulinemia: 2011 update on diagnosis, risk stratification, and management.
abstract: BACKGROUND
  Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, and lymphadenopathy.
  
  
  METHODS
  Presence of IgM monoclonal protein associated with 10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis.
  
  
  METHODS
  Age, hemoglobin level, platelet count, b2-microglobulin, and monoclonal IgM concentrations are characteristics required for prognosis.
  
  
  METHODS
  Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Rituximab-based therapy is used in virtually all US patients with WM and can be combined with alkylating agent or purine nucleoside analogue, or both. The preferred Mayo Clinic nonstudy therapeutic induction is rituximab, cyclophosphamide, and dexamethasone. Future stem cell transplantation should be considered in induction therapy selection.
  
  
  CONCLUSIONS
  Bortezomib, thalidomide, lenalidomide, and bendamustine have all been shown to have activity in WM. Given WM’s natural history, reduction of complications will be a priority for future treatment trials.
authors.affiliation: Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. gertz.morie@mayo.edu
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001809:Blood Viscosity; D003520:Cyclophosphamide / Q000627:therapeutic use; D003663:Decision Trees; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D000069283:Rituximab; D012720:Severity of Illness Index; D008258:Waldenstrom Macroglobulinemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D000069283:Rituximab; D003907:Dexamethasone; D003520:Cyclophosphamide