Guide To Treating Waldenstrom Macroglobulinemia

May 6, 2023

Waldenstrom macroglobulinemia is a type of blood cancer that starts in the white blood cells. This cancer causes the bone marrow to make an abnormally high amount of irregular white blood cells, which end up crowding the circulatory system and the healthy blood cells throughout it. These cells make a protein called macroglobulin that builds up in the blood impairing healthy circulation and causes other complications. Waldenstrom macroglobulinemia may not cause symptoms for several years because it is slow growing. When symptoms do manifest, they include nosebleeds, easy bruising, fatigue, weight loss, gum bleeding, headaches, vision changes, fever, and numbness in the hands and feet. WM starts when one white blood cell develops DNA mutations that tell the cell to multiply rapidly. These cells also do not die when healthy white blood cells should. Diagnosis is made with blood testing and bone marrow biopsy.

There is a range of options used to treat Waldenstrom macroglobulinemia. Learn about these now.

Biological Therapy

Biological therapy is a treatment option that may be used in Waldenstrom macroglobulinemia patients. This type of treatment uses living organisms, chemicals from living organisms, or simulated lab versions of such compounds to treat disease. Certain types of cancer cells have markers or tags that can be identified in a laboratory. Once the type of tags, markers, or other features of the patient's cancer cells are identified, the individual's immune system can essentially be manipulated into destroying them. In a healthy individual, the immune system is strong enough to kill off any abnormal looking cells, including cancerous cells. However, when an individual develops Waldenstrom macroglobulinemia, the malignant cells have learned how to overcome the immune systems usual mechanisms for fighting off abnormal cells. Biological therapy uses the immune system's natural function by enhancing it and telling it what it needs to target and how to eliminate it effectively. Some biological therapies will stop the growth of the tumor directly, while others will indirectly help the patient's immune system eradicate the malignant cells.

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Bone Marrow Transplant

Some highly selective cases of Waldenstrom macroglobulinemia may be treated with the use of a bone marrow transplant in combination with chemotherapy. This method works by using very high doses of chemotherapy drugs to wipe out a considerable portion of the cells in the bloodstream and in the patient's bone marrow. These cells include healthy as well as malignant cells. Usually, these high concentrations of chemotherapy drugs are not used because they destroy far too many healthy cells in the bloodstream for the patient to live. This potent chemotherapy method also infiltrates and destroys the patient's healthy bone marrow past the point where the body can repair it. However, when treating Waldenstrom macroglobulinemia, a bone marrow or stem cell transplant can be used to replace the bone marrow and blood cells that have been wiped out by the potent doses of chemotherapy. This treatment option includes extended stays in a medical facility due to the body's vulnerability after the chemotherapy has been administered and while the transplanted cells migrate to the marrow and build new cells.

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Plasma Exchange

Plasma exchange or plasmapheresis is a treatment commonly used in Waldenstrom macroglobulinemia patients who have been affected in a certain way. Because the malignant white blood cells that occur in Waldenstrom macroglobulinemia produce a high level of macroglobulin, certain problems and complications can occur as it builds up in the blood. Too much macroglobulin can cause hyperviscosity syndrome where the blood has trouble moving through the vessels because it becomes too thick. Sometimes the macroglobulin will make the blood thicker in colder regions of the body such as the nose, ears, toes, and fingers. This complication is called cryoglobulin. Additionally, a buildup of macroglobulin can cause amyloidosis or the accumulation of a specific part of this protein in the kidneys and the heart. This buildup usually results in damage to the heart and kidney tissues. For Waldenstrom macroglobulinemia patients who are experiencing such complications, plasma exchange is an effective treatment option. During this procedure, a machine separates the plasma component of the blood from the rest of it, and it filters out the excess macroglobulin that has accumulated in the blood. As this process happens, the blood is consistently being returned to the patient's body.

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Chemotherapy

Chemotherapy is a way to treat cancer that involves anti-cancer drugs injected into a muscle, vein, under the skin, or taken by mouth. Chemotherapy drugs work by identifying, targeting, and killing any cells around the patient's body that are in the process of dividing. This mechanism is effective at killing malignant cells because they divide or multiply more rapidly and frequently than healthy cells do. While chemotherapy kills off many cancerous cells, it also kills off healthy cells in the process of cell division. It is for this reason that chemotherapy is administered in cycles. The chemotherapy cycles involve a specified period of regular treatment that may last several weeks. After that, the patient will go through a rest period to give their body an opportunity to recover. Due to the side effects of chemotherapy, other drugs may be used alongside chemotherapy in some Waldenstrom macroglobulinemia patients. Most of the side effects associated with chemotherapy will subside once treatment is finished.

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Targeted Therapy

Targeted therapy involves the use of certain drugs to target specific changes that only take place inside of cancerous cells. Because targeted therapy drugs work through the use of a different mechanism than chemotherapy drugs do, there are some circumstances where they may work when chemotherapy does not. There are three main types of targeted therapy drugs that can be used to effectively treat Waldenstrom macroglobulinemia patients. Proteasome inhibitors are targeted therapy drugs that keep the proteins in the cell that are responsible for controlling cell division from being broken down by proteasomes or enzyme complexes. MTOR inhibitors are a kind of targeted therapy drugs that work by targeting and deactivating the mTOR protein responsible for helping the cell grow and divide. Bruton tyrosine kinase inhibitors are a type of targeted therapy drug that works by stopping a protein called BTK that is responsible for helping the cancerous cells survive. Most targeted therapy drugs have less severe side effects than chemotherapy.

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