Waldenstrom’s Macroglobulinemia

Prepared by Sarah Waheed, M.D., Assistant Professor of Medicine and Caleb Raine

This is a patient with a diagnosis of IgM lambda lymphoplasmacytic lymphoma (Waldenstrom’s Macroglobulinemia) diagnosed in October 2005 and initially treated with Leukeran and Prednisone without response.  Patient presented at the Myeloma Institute  in January 1996 and was subsequently treated with eight cycles of FAMP (Fludarabine) followed by Rituxan, then Melphalan 200mg/m2 based autologous stem cell transplant in November 2000 due to relapsed disease. The patient later received six cycles of Velcade, Rituxan, and Dexamethasone followed by a total of six doses of Rituxan.  The patient was then observed on no therapy.

In May 2012, the patient presented with another relapse, this time with new development of FDG avid focal lesions on PET scan in shoulders and femur, The cytogenetics from one of the focal lesions  revealed 46, XY, add (6) (q27), add (8) (p23), in 11 cells.  Bone marrow did not show any evidence of lymphoma. Patient was prescribed only Zometa 4mg q 1 monthly.

On follow-up in November 2012, PET SCAN showed improvement:
-Left proximal femur has an SUVmax of 2.44, down from 3.7 previously.
-Right proximal humerus lesion is also down from 3.2 to 2.5.
-Focal lesion in the left proximal humerus is no longer visualized
-Focal lesions altogether are compared to three previously.

PET SCAN (above) and MRI images (below) showing disappearance of left shoulder and left femur lesions with Zometa only.