Assessment of Bone Marrow Response in Waldenström's Macroglobulinemia

Varghese, Abraham; Rawstron, Andy C.; Ashcroft, A. John; Moreton, Paul; Owen, Roger G.

doi:10.3816/clm.2009.n.013

Cited by 51 publications

(35 citation statements)

References 15 publications

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“…Clinicians should be mindful of rituximab-induced paradoxical initial increase of IgM or "IgM flare" prior to response assessment [76]. Additionally, the therapy administered should be taken into account as gradual IgM decrements and selective clearance of the CD20 + B − cell compartment with sparing of the CD138+ plasma cell compartment have been observed [77,78] with agents belonging to certain classes. A substantial decrease in the IgM component may not be observed initially with monoclonal antibodies, alkylating agents, and purine analogs and persistently high IgM levels should not necessarily be interpreted as treatment failure.…”

Section: How Should the Response To Therapy Be Assessed?mentioning

confidence: 98%

“…A substantial decrease in the IgM component may not be observed initially with monoclonal antibodies, alkylating agents, and purine analogs and persistently high IgM levels should not necessarily be interpreted as treatment failure. The half-life of IgM is relatively brief at approximately 5 days, but the median time to maximal response may inexplicably vary from 5 to N 20 months following the completion of therapy [74,77,[79][80][81]. Conversely, mTOR, BTK, or proteasome inhibitor-based therapies may be associated with profound reductions of IgM levels without optimal bone marrow responses, underscoring the importance of repeat bone marrow biopsy and, in the context of clinical trials, preferably serial bone marrow appraisal to assess for any discordance between serum IgM and marrow response.…”

Section: How Should the Response To Therapy Be Assessed?mentioning

confidence: 99%

See 1 more Smart Citation

Waldenström macroglobulinemia: What a hematologist needs to know

et al. 2015

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Section: How Should the Response To Therapy Be Assessed?mentioning

confidence: 98%

Section: How Should the Response To Therapy Be Assessed?mentioning

confidence: 99%

Waldenström macroglobulinemia: What a hematologist needs to know

et al. 2015

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“…However, delayed IgM monoclonal protein responses may cause important diffi culties in response assessment [61]. In addition, discrepancies between the kinetics of serum M protein reduction and the clearance of monoclonal B cells from the bone marrow have been reported [62].…”

Section: Prognostic Role Of Response To Treatmentmentioning

confidence: 99%

Risk stratification in Waldenström macroglobulinemia

Morel¹,

Merlini

2012

Expert Review of Hematology

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“…Barakat et al, also described 10 cases of WM with persistent monotypic plasma cells in bone marrow after therapy with absence of clonal B cells [5]. Varghese et al, reported the persistence of low level plasma cell clones in 5 patients with WM after chemotherapy using fludarabine alone or in combination with cyclophosphamide [6]. Goteri et al, described 2 patients with LPL who had clusters of monotypic plasma cells in BM after rituximab therapy [7].…”

Section: Case Reportmentioning

confidence: 99%

Persistent Monotypic Plasma Cells with Absence of Neoplastic B Cell Component in a Treated Case of Waldenström Macroglobulinemia: A Sign of Residual Disease?

Gajendra

Sachdev

Jha

et al. 2014

JCDR

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A 57-year-old male, known case of chronic inflammatory demyelinating polyneuropathy with POEMS Syndrome (Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) presented with generalized weakness. Peripheral blood smear findings were within normal limits. Bone marrow smears showed mild increase in lymphoid cells including many lymphoplasmacytoid cells and increased in plasma cells. Bone marrow biopsy revealed hypercellular marrow spaces with small and large lymphoid aggregates interstitially and in paratrabecular location along with few plasma cell clusters. On immunohistochemistry, these lymphoid aggregates were CD20 positive with lambda restriction, and CD 56, CD5 and CD10 negative [ ABSTRACT Waldenström macroglobulinemia (WM) is a rare indolent variant of non-Hodgkin's lymphoma characterised by lymphoplasmacytic infiltration of bone marrow (BM) associated with a serum IgM paraprotein. The WHO classification states that the neoplastic cells of WM usually are positive for monotypic surface immunoglobulin light chain, IgM, CD19, and CD20 and are negative for CD5, CD10, and CD23. Serum monoclonal protein detection by serum protein electrophoresis and bone marrow aspirate and biopsy are required for WM diagnosis, monitoring and response assessment. Pathologist must dissuade themselves from making a hasty decision on calling a complete response in WM when neoplastic B cell component is absent. Evaluation of clonality of any residual plasma cells must be done in all cases of WM to evaluate the presence and extent of residual or persistent disease. Role of additional therapy targeted at these residual plasma cells in WM can be evaluated as tools for achieving complete remission. Herein, we present a case of WM with residual monotypic plasmacytosis in BM, without B lymphocytes after therapy.

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Assessment of Bone Marrow Response in Waldenström's Macroglobulinemia

Cited by 51 publications

References 15 publications

Waldenström macroglobulinemia: What a hematologist needs to know

Waldenström macroglobulinemia: What a hematologist needs to know

Risk stratification in Waldenström macroglobulinemia

Persistent Monotypic Plasma Cells with Absence of Neoplastic B Cell Component in a Treated Case of Waldenström Macroglobulinemia: A Sign of Residual Disease?

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