Waldenströ m macroglobulinemia (WM) is
IntroductionWaldenström macroglobulinemia (WM) is an indolent, nonHodgkin lymphoma characterized by bone marrow infiltration and the overproduction of monoclonal immunoglobulin M protein (IgM). 1 Accounting for 1% to 2% of hematologic malignancies, this rare lymphoma, which is often, if not always, preceded by an IgM monoclonal gammopathy of undetermined significance, is more common in males, with a median age at presentation of 63 years. 2 The exact cause of WM is unknown, but multigenerational clustering and familial patterns suggest the possibility of an underlying genetic defect. 3,4 However, cytogenetic analyses have yet to reveal a common abnormality specific to WM disease, as has been reported in other lymphoproliferative disorders. 5,6 Whereas recent gene expression and proteomics studies have advanced our understanding of WM pathogenesis and identified potential therapeutic targets, WM remains incurable given current therapy, with a 5-year survival rate of 50%. 7,8 WM is classified by the World Health Organization as a lymphoplasmacytic lymphoma, and bone marrow aspirates collected from patients with WM reveal a diverse tumor clone consisting of a spectrum of small B lymphocytes, plasma cells, and lymphoplasmacytoid cells. 9 Evidence suggests that WM may arise from a postgerminal center, memory-like B cell that has developed the capacity to secrete IgM through either intrinsic or extrinsic stimuli. Thus, in addition to the positive expression of soluble immunoglobulin IgM and the pan B-cell antigens CD19 and CD20, many WM tumor cells also coexpress the markers of mature plasma cells as well, including CD38 and CD138. 10,11 Clinical findings associated with this malignancy, including mucosal bleeding, retinopathies with visual disturbances, and neuropathies and paresthesias, frequently arise as a result of hyperviscosity syndrome, the development of which is directly related to the high serum levels of IgM. 2,12 Despite its association with significant morbidity, the deregulation of IgM production in WM remains poorly understood. To date, exploratory studies to determine the pathogenesis of IgM dysregulation in WM have been limited mainly by the lack of a validated cell model that is both phenotypically and genetically consistent with the original primary tumor. The WSU-WM cell line was one of the first established from a WM tumor. However, WSU-WM cells maintain a karyotype and morphology more reminiscent of Burkitt lymphoma than WM; and because the cell line was never genetically authenticated against the primary tumor, the exact origin of these cells remains unclear. 13 BCWM.1 cells correspond phenotypically to primary WM cells in their ability to secrete high levels of IgM, and this putative WM cell line has frequently been used as a representative model of this disease. 14 Unfortunately, data confirming a clonal relationship between BCWM.1 cells and the primary tumor from which they were derived are limited. Although these cells remain a useful model for the stu...