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Initial treatment of Waldenström macroglobulinemia

Initial treatment of Waldenström macroglobulinemia
This algorithm describes our preferred management of patients with newly diagnosed WM. There are other acceptable approaches. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.
WM: Waldenström macroglobulinemia; BTK: Bruton tyrosine kinase.
* Indications for treatment:
  • Recurrent fever, night sweats, weight loss, fatigue
  • Hyperviscosity
  • Lymphadenopathy that is either symptomatic or bulky
  • Symptomatic hepatomegaly and/or splenomegaly
  • Symptomatic organomegaly and/or organ or tissue infiltration
  • Peripheral neuropathy due to WM
  • Symptomatic cryoglobulinemia
  • Cold agglutinin hemolytic anemia
  • Immune hemolytic anemia and/or thrombocytopenia
  • Nephropathy related to WM
  • Amyloidosis related to WM
  • Hemoglobin of 10 g/dL or less
  • Platelet count of 100 × 109/L or less
¶ Symptoms of hyperviscosity include oronasal bleeding, blurred vision, headaches, dizziness, paresthesias, retinal vein engorgement and/or flame-shaped hemorrhages, papilledema, stupor or coma.
Δ Continuous therapy with a BTK inhibitor is an acceptable alternative for patients who decline chemotherapy.
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