Waldenström macroglobulinaemia
Prepared with OnCo (onco.cc/prep/waldenstrom/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
14 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example MYD88 L265P, CXCR4 mutation, Serum IgM and viscosity, IPSSWM / rIPSSWM, Anti-MAG antibodies), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (asymptomatic), which of the standard options do you recommend and why?
- 6.For my situation (symptomatic, first line), which of the standard options do you recommend and why?
- 7.Am I a candidate for Bendamustine, Rituximab, Zanubrutinib or related drugs, and what side effects should I expect?
- 8.For my situation (relapsed), which of the standard options do you recommend and why?
- 9.Am I a candidate for Bortezomib, Carfilzomib, Venetoclax or related drugs, and what side effects should I expect?
- 10.Are there clinical trials I could join, for example of Pirtobrutinib, Venetoclax, Zanubrutinib?
- 11.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 12.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 13.I read that “Indefinite BTKi therapy: cost, toxicity and resistance (BTK C481S)”. How does that affect my plan?
- 14.I read that “CXCR4-mutant disease responds slower and shallower”. How does that affect my plan?
The words I may hear
- IGHV mutational status: Whether the leukaemia's antibody gene has been 'edited' by the immune system.
- Histologic transformation: When a lung adenocarcinoma escapes targeted therapy by turning into a different cell type, usually small-cell.
Tests and results to bring
Biomarker results to ask for: MYD88 L265P (AS-PCR/NGS), CXCR4 mutation (S338X and others), Serum IgM and viscosity, IPSSWM / rIPSSWM, Anti-MAG antibodies (neuropathy), Cryoglobulins, cold agglutinins.
Scans and tests linked to this cancer: Active surveillance.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Asymptomatic: Observation; treat on symptoms, cytopenias, hyperviscosity or neuropathy, not on IgM level alone. (Active surveillance)
- Symptomatic, first line: Bendamustine-rituximab or dexamethasone-rituximab-cyclophosphamide for fixed duration; or zanubrutinib / ibrutinib (± rituximab) continuously; plasmapheresis first for hyperviscosity. (Bendamustine, Rituximab, Zanubrutinib, Ibrutinib)
- Relapsed: Switch class (BTKi ↔ chemo-immunotherapy); bortezomib- or carfilzomib-based regimens; venetoclax; pirtobrutinib after covalent BTKi; autologous transplant in selected young patients. (Bortezomib, Carfilzomib, Venetoclax, Pirtobrutinib, Autologous stem cell transplant (high-dose therapy))
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.