IWWM-12 2024 | The diverse presentation of symptoms in patients with Waldenström’s macroglobulinemia

There’s a very broad spectrum of how people present. There is a subset of patients who really are picked up entirely incidentally. They went in for a physical exam and they were noted to have a slightly low hemoglobin, a little bit anemic, and people followed up on that. Sometimes they even just with some abnormalities in their blood tests, including what is called rouleaux formation, where all the cells seemed a little bit sticky and sticking to each other and somebody tests the proteins and finds there’s a monoclonal protein. Those patients have really no other symptoms aside from the fact that they were picked up on a blood test. Typically those are watchful waiting kinds of patients and may just have an IgM monoclonal gammopathy of uncertain significance or even smoldering Waldenstrom’s. We then find others that present with symptoms and those symptoms I think come in sort of two categories. The first is the symptoms associated with lots of extra Waldenstrom’s cells. So as these cells accumulate in the bone marrow or sometimes in lymph nodes of the spleen, the increase in the bone marrow causes anemia, causes low platelets and that kind of thing which people might then go to the doctor and be evaluated for. On the other hand, all the problems that come from the protein and what happens there is the blood can become thick and you can get hyperviscosity-like symptoms but also those protein molecules are very sticky and so they can stick for example to nerves giving neuropathy stick to red cells causing additional anemia or deposit in the tissue causing problems such as amyloidosis. Each of those have a variety of different types of symptoms that can develop but quite honestly depending on where your protein or the cells are kind of interfering, that’s what really drives the symptoms.