On March 29, 2022, the International Waldenström’s Macroglobulinemia Foundation (IWMF) hosted a webinar titled “An Overview of Amyloidosis and WM with Dr. Morie Gertz.” The goal of this program was to educate patients about the relationship between Waldenström’s and amyloidosis. While amyloidosis is quite rare in people living with Waldenström’s macroglobulinemia, a small percentage of patient do ultimately develop it, significantly complicating their case.
About Waldenström’s Macroglobulinemia (WM)
Waldenström’s macroglobulinemia, which is also known as lymphoplasmacytic lymphoma, is a rare type of blood cancer that affects two types of B lymphocytes, including plasma cells and lymphoplasmacytoid cells. A distinct characteristic of this type of cancer is the presence of a high concentration of IgM antibodies. It is a slow progressing form of blood cancer, and many patients can lead active lives. While it cannot be cured, it is treatable; some patients are able to experience years of remission without symptoms. There are only about 1,500 new cases per year in the U.S. Although it mostly occurs due to sporadic genetic mutations, a family history increases risk. Symptoms include vision loss, headaches, enlargement of the lymph nodes, liver, and spleen, bleeding nose and gums, weight loss, fatigue, and general weakness. To learn more about WM, click here.
Amyloidosis is a group of diseases which are characterized by the build up of amyloid fibrils in body tissue. Amyloid fibrils are a type of abnormal protein. As there are several different types of amyloidosis, the cause can vary. Some forms are acquired while others are linked to genetic factors. The most common form is amyloid light-chain (AL) amyloidosis. Symptoms of the disease include swelling, heart failure, irregular heartbeat, shortness of breath, fatigue, weight loss, easy bruising and bleeding, stroke, lung problems, enlarged liver, and changes in skin color. Treatment approaches for amyloidosis include chemotherapy and stem cell transplant; other options vary depending on the type of amyloidosis. Prognosis varies depending on the type; AL amyloidosis has a median survival of one or two years without treatment. To learn more about amyloidosis, click here.
Amyloidosis and WM
Light-chain amyloidosis is the form that is associated with Waldenström’s. As immunoglobulin M (IgM) is produced an abnormally high amounts in the cancer, this antibody is most likely to become amyloid in patients. Only around three percent of people with Waldenström’s macroglobulinemia develop amyloidosis, making it a relatively rare, but also rather serious, complication.
Dr. Gertz notes that systemic and localized amyloidosis can appear in this group of patients. Amyloid protein often builds up in certain areas of the body, leading to reduced organ function or even organ failure. He referred to prior research which found that IgM amyloidosis tended to have a lower degree of heart involvement compared to other forms. There was also a reduced chance of multiple organ involvement with this form. This form of amyloidosis was more likely to affect the nervous system, lungs, and soft tissue, however.
Involvement of the liver was also found to be a significant factor for prognosis. Meanwhile, early diagnosis and a stem cell transplant tended to be linked to better outcomes. If a Waldenström’s macroglobulinemia patient presents with proteinuria (protein in the urine), amyloidosis is most likely the cause.
Treatment often involves chemotherapy that targets the cells in the bone marrow that are producing the IgM that becomes amyloid.