Skip to main content

Advertisement

SpringerLink
Log in

Immunoglobulin M ‘Flare’ Seen in a Case of Waldenstrom’s Macroglobulinemia: Successfully Managed by Therapeutic Plasma Exchange

  • Case Report
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Therapeutic plasma exchange (TPE) is a conjunctive modality of treatment along with rituximab to decrease paraproteinemia associated with hyperviscosity. Here we narrate our experience in treating a diagnosed case of Waldenstrom’s macroglobulinemia in 70 years old male patient with moderate anemia and severe features of hyperviscosity syndrome by serial TPE and rituximab combined with bortezomib. The patient was relieved of his symptoms after initial two TPE procedures performed on alternative day. However he again developed signs and symptoms of the disease within 6 weeks following second TPE and starting of rituximab (375 mg/m2 weekly for 4 weeks) therapy with bortezomib. His serum IgM level became as high as 9.901 g/dl suggesting immunoglobulin M ‘Flare’ due to rituximab therapy. At the end of third TPE he was relieved symptomatically with low IgM level (3.13 g/dl) and discharged in hemodynamically stable condition. Therefore we concluded that careful monitoring of serum viscosity and IgM level are necessary during treatment with rituximab based chemotherapy and TPE should be promptly initiated to control the treatment related hyperviscosity syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Swerdlow SH (2008) WHO classification of tumours of haematopoietic and lymphoid tissues, vol 2. World Health Organization, Geneva, p 200

    Google Scholar 

  2. Owen RG, Treon SP, Al-Katib A et al (2003) Clinicopathological definition of Waldenstrom’s macroglobulinemia: consensus panel recommendations from the second international workshop on Waldenstrom’s macroglobulinemia. Semin Oncol 30(2):110–115

    Article  PubMed  Google Scholar 

  3. Kyle RA, Treon SP, Alexanian R et al (2003) Prognostic markers and criteria to initiate therapy in Waldenstrom’s macroglobulinemia: consensus panel recommendations from the second international workshop on Waldenstrom’s macroglobulinemia. Semin Oncol 30(2):116–120

    Article  PubMed  Google Scholar 

  4. Gertz MA, Anagnostopoulos A, Anderson K et al (2003) Treatment recommendations in Waldenstrom’s macroglobulinemia: consensus panel recommendations from the second international workshop on Waldenstrom’s macroglobulinemia. Semin Oncol 30(2):121–126

    Article  PubMed  Google Scholar 

  5. Treon SP, Gertz MA, Dimopoulos MA et al (2006) Update on treatment recommendations from the third international workshop on Waldenstrom’s macroglobulinemia. Blood 107(9):3442–3446

    Article  CAS  PubMed  Google Scholar 

  6. Dimopoulos MA, Gertz MA, Kastritis E et al (2009) Update on treatment recommendations from the fourth international workshop on Waldenstrom’s macroglobulinemia. J Clin Oncol 27(1):120–126

    Article  PubMed  Google Scholar 

  7. Ailawadhi S, Kardosh A, Yang D, Cozen W, Patel G, Alamgir MA et al (2014) Outcome disparities among ethnic subgroups of Waldenstrom’s macroglobulinemia: a population-based study. Oncology 86(5–6):253–262

    Article  PubMed  Google Scholar 

  8. Dimopoulos MA, Anagnostopoulos A (2005) Waldenstrom’s macroglobulinemia. Best Pract Res Clin Haematol 18(4):747–765

    Article  CAS  PubMed  Google Scholar 

  9. Gertz MA (2015) Waldenstrom macroglobulinemia: 2015 update on diagnosis, risk stratification, and management. Am J Hematol 90(4):346–354

    Article  CAS  PubMed  Google Scholar 

  10. Dimopoulos MA, Kastritis E, Owen RG et al (2014) Treatment recommendations for patients with Waldenstrom macroglobulinemia (WM) and related disorders: IWWM-7 consensus. Blood 124(9):1404–1411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ghobrial MI, Fonseca R, Greipp PR et al (2004) Initial immunoglobulin M ‘Flare’ after rituximab therapy in patients diagnosed with Waldenstrom macroglobulinemia. Cancer 101:2593–2598

    Article  CAS  PubMed  Google Scholar 

  12. Stone MJ (2009) Waldenstrom’s macroglobulinemia: hyperviscosity syndrome and cryoglobulinemia. Clin Lymphoma Myeloma 9(1):97–99

    Article  PubMed  Google Scholar 

  13. Mackenzie MR, Babcock J (1975) Studies of the hyperviscosity syndrome. II. Macroglobulinemia. J Lab Clin Med 85(2):227–234

    CAS  PubMed  Google Scholar 

  14. Szczepiorkowski ZM, Winters JL, Bandarenko N et al (2010) guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 25(3):83–177

    Article  PubMed  Google Scholar 

  15. Drew MJ (2003) Apheresis: principles and practice. In: Mc Leod BC (ed) Therapeutic plasma exchange in hematologic diseases and dysproteinemias, 2nd edn. AABB Press, Bethesda, pp 364–365

    Google Scholar 

  16. Bloch KJ, Make DG (1973) Hyperviscosity syndromes associated with immunlglobulin abnrmalities. Semin Hematol 10:113–124

    CAS  PubMed  Google Scholar 

  17. Morel P, Duhamel A, Gobbi P et al (2009) International prognostic scoring system for Waldenstrom macroglobulinemia. Blood 113(18):4163–4170

    Article  CAS  PubMed  Google Scholar 

  18. Treon SP, Branagan AR, Hunter Z et al (2004) Paradoxical increases in serum IgM and viscosity levels following rituximab in Waldenstrom’s macroglobulinemia. Ann Oncol 15:1481–1483

    Article  CAS  PubMed  Google Scholar 

  19. Yang G, Xu L, Hunter ZR et al (2010) The rituximab and IVIG related IgM flare in Waldenstrom’s macroglobulinemia is associated with monocytic activation of FCGR2A signaling and triggering of IL-6 release by the PI3K/AKT and MAPK pathways. Blood 116(Abstract 2870):107

    Google Scholar 

  20. Treon PS, Merlini G (2012) Waldenstrom macroglobulinemia and lymphoplasmacytic lymphoma. In: Hoffman R (ed) Hematology: basic principles and practice, 6th edn. Elsevier, Amsterdam, p 1346

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Transfusion Medicine, The Mission Hospital, Sector-2C, Immon Kalyan Sarani, Bidhannagar, Durgapur, West Bengal, 713212, India

    Suvro Sankha Datta

  2. Department of Transfusion Medicine, AIIMS, Bhubaneswar, Odisha, 751019, India

    Somnath Mukherjee

  3. Department of Immunohematology & Blood Transfusion, MCH, Kolkata, West Bengal, 700073, India

    Biplabendu Talukder & Prasun Bhattacharya

Authors
  1. Suvro Sankha Datta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Somnath Mukherjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Biplabendu Talukder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prasun Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suvro Sankha Datta.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Datta, S.S., Mukherjee, S., Talukder, B. et al. Immunoglobulin M ‘Flare’ Seen in a Case of Waldenstrom’s Macroglobulinemia: Successfully Managed by Therapeutic Plasma Exchange. Indian J Hematol Blood Transfus 32 (Suppl 1), 148–151 (2016). https://doi.org/10.1007/s12288-015-0603-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-015-0603-5

Keywords

Search

Navigation