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Non Hodgkins Lymphoma Case Studies

Case Studies: Waldenstrom Macroglobulinemia in a Newly Diagnosed Patient

Jorge J. Castillo, MD, shares insight on the diagnosis and management of a 65-year-old woman who presents with Waldenstrom’s macroglobulinemia.

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; MYD88L265P 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
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