title: Waldenström macroglobulinemia: 2013 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
  The presence of IgM monoclonal protein associated with ≥10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis.
  
  
  METHODS
  Age, hemoglobin level, platelet count, β2 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 analog (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, everolimus, 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, Rochester, MN 55905, USA. gertz.morie@mayo.edu
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
mesh_terms: D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000097:blood; D004502:Education, Medical, Continuing; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D010976:Platelet Count; D012307:Risk Factors; D008258:Waldenstrom Macroglobulinemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D000911:Antibodies, Monoclonal; D006454:Hemoglobins; D007075:Immunoglobulin M; D001613:beta 2-Microglobulin