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 (45281 mg/dL)
- Serum viscosity; 3.7 centipoise (cP) (1.61.9 cP)
- Beta-2; 3 mg/L (0-2.7 mg/L)
- IPSSWM: 2 Intermediate
- Bone marrow aspiration and biopsy; 4050% 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; MYD88L265Pmutation
- 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