title: A survey on diagnostic methods and treatment strategies used in patients with Waldenström's macroglobulinaemia in The Netherlands.
abstract: BACKGROUND
  Waldenström's macroglobulinaemia (WM) is defined as a lymphoplasmacytic lymphoma primarily located in the bone marrow, accompanied by an immunoglobulin M (IgM) monoclonal protein in the serum. The symptoms are highly variable, which can sometimes lead to a diagnostic delay. Currently, there is a wide range of therapeutic options used for the management of WM but no approved therapeutic agents are available specifically for this disease.
  
  
  METHODS
  An online survey was prepared and sent out to haematologists and haemato-oncologists in The Netherlands, together with an invitational letter to participate. Information was gathered about the preferred methods of diagnosing and treating patients with WM in general, and about the last WM patient diagnosed in their department.
  
  
  RESULTS
  83 (31.8%) responses were obtained, out of which 68 (81.9%) contained responses to all three parts of the survey. The respondents most commonly used either rituximab-CVP or chlorambucil as first-line treatment, whereas rituximab in combination with purine analogues was the most frequently applied second-line treatment. The prevention of an IgM 'flare' was managed by the respondents in various ways, and rituximab maintenance treatment was not commonly used.
  
  
  CONCLUSIONS
  This survey indicates that in general the diagnostic methods and treatment options for WM are well known to a representative number of Dutch haematologists. The areas of uncertainty are knowledge about asymptomatic vs symptomatic disease, risk of hyperviscosity in relation to IgM level, and the occurrence and prevention of an IgM 'flare'. These issues should be addressed in clinical research and guidelines to improve care for WM patients in The Netherlands.
authors: Department of Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: S
authors: S
authors: Klodzinska
authors: J M I
authors: JM
authors: Vos
authors: M J
authors: MJ
authors: Kersten
authors: P
authors: P
authors: Wijermans
authors: M C
authors: MC
authors: Minnema
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D006405:Hematology / Q000379:methods*; D006801:Humans; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis* / Q000188:drug therapy*