Case Studies

Expert physicians provide insight on managing oncology-based patient cases that highlight the use of novel agents in clinical practice.

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Waldenstrom Macroglobulinemia in a Newly Diagnosed Patient

Case: A 65-Year-Old Female With Newly Diagnosed Waldenström Macroglobulinemia

September 2016

A 65-year old female presented to her PCP with slowly progressing anemia for the last couple of years
Several months prior to that, she began experiencing drenching night sweats, distended abdomen, and 15 lb weight loss
SH: Married, exercises regularly, social drinker, non-smoker, no illicit drug use
FH: Maternal aunt – breast cancer age 51
Laboratory results:
- Hemoglobin; 7 g/dL (11-13 g/dL), platelets; 55,000/mm³ (155,000-410,000/mm³), and leukocyte count 1,700/mm³ (3,800-9,200/mm³).
- M-protein; 2991.3 mg/dL; IgM 4710 mg/dL (45–281 mg/dL)
- Serum viscosity; 3.7 centipoise (cP) (1.6–1.9 cP)
- Beta-2; 3 mg/L (0-2.7 mg/L)
- IPSSWM: 2 Intermediate
Bone marrow aspiration and biopsy; 40–50% B cells
Flow cytometry; Lambda-restricted B cells that expressed CD19 and CD20
B cells were negative for CD5, CD10, CD43, bcl-1, and bcl-6
Allele-specific PCR; MYD88^L265P mutation
Diagnosis; Waldenström’s macroglobulinemia (WM)

Treatment

Patient was started on ibrutinib (420 mg) daily with monthly follow-up visits
After three months, her IgM was 1500 mg/dL and her serum viscosity was 1.5 cP
Her CBC showed improvements: WBC, 5000/mm³, Hgb 15.5g/dL; platelets 180,000/mm³
The patient was last seen on follow-up last month and she continues on ibrutinib 2 years after her initial presentation