Treatment for Waldenström macroglobulinaemia (WM)
The type of treatment you’ll need will depend on how far the Waldenström macroglobulinaemia (WM) has developed.
Active monitoring (watch and wait)
If you don’t have many symptoms when you’re diagnosed, and the WM isn’t affecting your general health or wellbeing, you may not need treatment straight away. Instead, you’ll be put on active monitoring – also known as watch and wait – and have regular check-ups every three to six months.
We have more information about active monitoring.
Plasma exchange
If there’s a large amount of IgM in your blood and it becomes too thick, plasma exchange treatment (also called plasmapheresis) can be used to help thin your blood to help it flow better through your blood vessels.
This treatment takes a few hours each time and uses a machine called a cell separator to remove the IgM from your blood.
Drug treatments
Different types of drug work in different ways to control the LPL (cancer) cells. Don’t be afraid to ask your doctor about the drugs they are recommending and why they are best for you.
The choice of drugs will depend on the problems caused by the LPL cells and paraprotein, and how quickly your paraprotein level needs to be controlled. It also depends on how well your body can cope with the treatment.
You will usually have a combination of two or three drugs to treat WM.
Chemotherapy drugs are anti-cancer drugs which kill cancer cells or stop them growing.
Chemotherapy drugs are often given in combination with other drugs such as rituximab and a steroid. They may be given as a drip into a vein (an intravenous infusion) or as tablets.
The main chemotherapy drugs given with rituximab are either bendamustine or cyclophosphamide. Both drugs are alkylating agents which stop the LPL cells growing and dividing by interfering with DNA inside the cell.
Rituximab is a drug called a monoclonal antibody. It is used in most drug combinations for WM. It targets your B cells and helps your immune system to destroy the LPL cells. It is given as a drip into a vein (an intravenous infusion).
Steroids such as dexamethasone or prednisolone are given alongside chemotherapy drugs to help them work better.
Inhibitors target cancer cells by blocking the proteins that make them grow or stop them dying.
Zanubrutinib is a type of inhibitor called a BTK inhibitor (bruton tyrosine kinase inhibitor) which is approved to treat WM. It is taken as tablets at home.
Stem cell transplant
If the WM doesn’t respond well to chemotherapy or chemo-immunotherapy, or if the disease comes back quickly, you may be offered a stem cell transplant.
Although a stem cell transplant can be a very effective treatment, it does carry some risks, and it’s not suitable for everyone with WM. Talk to your hospital team about which treatments are an option for you.
For more information on stem cell transplants, order or download our booklet Blood stem cell and bone marrow transplants: The seven steps.
Follow up appointments
After treatment, you’ll need follow-up appointments with your GP or hospital haematology department to check the levels of IgM in your blood. This can be done through a blood test. You and your doctors will also need to look out for any new symptoms.
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