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^L265Pmutation
• 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