Waldenstrom’s macroglobulinemia (WM) — also known as lymphoplasmacytic lymphoma — is a rare blood cancer that forms in cells of the immune system. A form of non-Hodgkin lymphoma (NHL), WM is a slow-growing disease that may cause a variety of signs and symptoms.

What Is Waldenstrom's Macroglobulinemia?

WM forms in a type of white blood cells called B lymphocytes, or B cells. B cells function as part of the immune system. They help the body recognize and fight infections with proteins known as antibodies, which are made to recognize foreign entities. The cancer cells in WM make abnormally high levels of an antibody called immunoglobulin M (IgM). The antibody molecules made by the cancer cells are all identical and are therefore called a monoclonal protein, or M protein.

WM generally forms in the bone marrow. The cancer cells multiply and overtake the normal healthy cells in the bone marrow, causing a decrease in the levels of red blood cells, white blood cells, and platelets. However, people living with WM can also present with a normal blood count. Cancer cells can also form in other tissues such as the liver and spleen, leading to swelling of the tissues.

Signs and Symptoms of Waldenstrom's Macroglobulinemia

The growth of cancer cells in the body can cause several signs and symptoms in a person with Waldenstrom's macroglobulinemia. A symptom is a physical manifestation of a condition experienced by the person, but it’s not necessarily outwardly observed, such as a headache. A sign is physical evidence of a disease that can be observed by others, such as a rash. Notably, a sign may or may not be symptomatic, meaning a person with the sign may not be aware of it.

Common signs and symptoms of WM include:

• Fever
• Night sweats
• Unexplained weight loss
• Weakness due to low red blood cell count
• Numbness in the hands and feet
• Loss of appetite
• A bleeding syndrome or abnormal tests of the blood clotting system

Many of these common symptoms are experienced with other forms of NHL. There are also signs and symptoms of WM that are more uncommon, which include:

• Swollen lymph nodes
• Abnormal bleeding
• Vision problems
• Kidney problems
• Congestive heart failure
• Circulation system problems, causing dizziness and slurred speech
• Sensitivity to cold
• Digestive issues
• Increased infections
• Bleeding from the nose and gums
• Tingling in the fingers and toes
• Enlarged liver, spleen, or lymph nodes

Because WM is a slow-growing disease, many of these symptoms can manifest gradually over a number of years. If you experience symptoms that cannot be directly observed, let your doctor know about them as soon as possible.

Tests for Signs of Waldenstrom's Macroglobulinemia

If a person is noticing symptoms of WM, a doctor may order a series of diagnostic tests to measure signs of the disease. Most of these signs are measured using a blood test, urine test, or bone marrow biopsy. The signs include the following.

Low Blood Cell Counts

A complete blood cell count (CBC) is a blood test that measures levels of red blood cells, white blood cells, and platelets. The growth of WM cancer cells can cause the levels of each blood cell type to be too low, leading to different symptoms.

Red Blood Cells

Red blood cells are cells in the blood and bone marrow that are responsible for carrying oxygen throughout the body. A low level of red blood cells is called anemia, which can cause symptoms such as:

• Fatigue
• Weakness
• Paleness

White Blood Cells

White blood cells are cells of the immune system that help the body fight against infection. A low level of white blood cells is known as leukopenia. Although leukopenia may not cause symptoms in many cases, some people can have symptoms of infection such as:

• Chills
• Sweating
• Fever above 100.4 F

Platelets

Platelets are cells required for normal blood clotting. Low levels of platelets can cause symptoms such as:

• Profuse bleeding from a small cut or wound
• Heavy menstrual bleeding
• Easy bruising
• Bloody stool
• Nosebleeds

High Immunoglobulin Levels

Levels of immunoglobulin antibodies can be measured to detect abnormally high levels of IgM produced by cancer cells in WM. The levels can be determined using a test known as serum protein electrophoresis, which measures the levels of certain proteins in a blood or urine sample.

High Beta 2 Microglobulin Levels

Beta 2 microglobulin (B2M) is a protein produced by B cells. WM may cause high levels of B2M, which can also be an indicator of poor prognosis (lower chance of survival).

Presence of Cold Agglutinins

A blood test can be performed to detect cold agglutinins, which are antibodies that attack red blood cells at temperatures below 98.6 degrees F. The dead red blood cells form clumps and can block flow through blood vessels.

High Percentage of Cryoglobulins

Cryoglobulins are antibodies that clump together in cooler temperatures, which can block flow through blood vessels and cause symptoms. A blood test can help measure the percentage of clumped cryoglobulins in the blood. People with WM may have a higher-than-normal percentage of cryoglobulins.

Hyperviscosity Syndrome

People with WM may have blood that is abnormally viscous (thick). This sign is known as hyperviscosity syndrome and is caused by the high levels of IgM produced by WM cells.

Treatment-Related Side Effects

The most standard forms of treatment for WM — chemotherapy and radiation therapy — can have side effects, including:

• Increased risk of infection
• Bruising
• Anemia
• Change in taste or smell
• Nausea or vomiting
• Diarrhea
• Abdominal pain
• Inflammation of the mouth
• Fatigue
• Negative impact on fertility

Managing Signs, Symptoms, and Side Effects of Waldenstrom's Macroglobulinemia

Disease symptoms can have a negative impact on one’s daily life and outlook. People living with symptoms of WM can benefit from palliative care. Palliative care is a type of medical care focused on improving the quality of life for people living with chronic diseases and helping to manage symptoms.

Managing side effects is also important for people receiving treatment for WM. There are medications to help manage side effects such as nausea and diarrhea. Maintaining a healthy lifestyle with diet and exercise can also help to improve quality of life.

Connect With Others Who Understand

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Are you or a loved one living with symptoms of Waldenstrom's macroglobulinemia? Share your experience at MyLymphomaTeam, or comment below to start a conversation.