Waldenstrom Macroglobulinemia with Jaundice as the Initial Manifestation: A Report of One Case and Literature Review_West China Medical Journal

Authors：

 WangYanyu ¹ , YangZhengbing ² ,  XuCaigang ¹

1. Department of Hematology / Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XuCaigang, Email: xucg@cd120.com

Keywords：

Jaundice; Waldenstrom macroglobulinemia; Diagnosis; Therapy

DOI：

10.7507/1002-0179.201600236

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To improve the understanding, diagnosis and treatment of special clinical characteristics of Waldenstrom macroglobulinemia (WM). Methods We described one case of WM which initially presented with jaundice, and discussed the clinical characteristics, diagnosis and therapeutics based on the literature review. Results WM is a B-cell lymphoproliferative disorder characterized by an immunoglobulin M (IgM) monoclonal gammopathy and bone marrow infiltration by lymphoplasmacytic lymphoma, which generally affects elderly patients. WM with primary jaundice is rare in clinic, which is usually misdiagnosed and has missed diagnosis. Patients should have their IgM monitored first before accepting therapeutic regimen including rituximab in order to avoid IgM flare or related complications. Conclusions The potential diagnosis of malignant plasma cell disorder should be considered for those patients who presented with jaundice initially, after liver system diseases are excluded. Liver biopsy and related examinations are necessary without delay. Prophylactic plasmapheresis is an active means to lower the incidence of IgM flare, especially for patients with a pre-therapy IgM level of higher than 50 g/L.

Citation： WangYanyu, YangZhengbing, XuCaigang. Waldenstrom Macroglobulinemia with Jaundice as the Initial Manifestation: A Report of One Case and Literature Review. West China Medical Journal, 2016, 31(5): 867-870. doi: 10.7507/1002-0179.201600236 Copy

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7.	Takahashi K, Yamamura F, Motoyama H. IgM myeloma--its distinction from Waldenstrom’s macroglobulinemia[J]. Acta Pathol Jpn, 1986, 36(10) : 1553-1563.
8.	Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma[J]. Mayo Clin Proc, 2003, 78(1) : 21-33.
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10.	Owen RG, Pratt G, Auer RL, et al. Guidelines on the diagnosis and management of Waldenstrom macroglobulinaemia[J]. Br J Haematol, 2014, 165(3) : 316-333.
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12.	Zelenetz AD, Gordon LI, Wierda WG, et al. Non-Hodgkin’s lymphomas, version 4.2014[J]. J Natl Compr Canc Netw, 2014, 12(9) : 1282-1303.
13.	Reddy KR, Beavers KL, Hammond SP,et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy[J]. Gastroenterology, 2015, 148(1) : 215-219.
14.	Izzedine H, Bourry E, Amrouche L, et al. Immunoglobulin M “Flare” after rituximab-associated acute tubular necrosis in Waldenström’s macroglobulinemia[J]. Int J Hematol, 2009, 89(2) : 218-222.
15.	Noronha V, Fynan TM, Duffy T. Flare in neuropathy following rituximab therapy for Waldenstrom’s macroglobulinemia[J]. J Clin Oncol, 2006, 24(1) : e3.
16.	于亚平, 翟勇平, 史平, 等. 利妥昔单抗治疗华氏巨球蛋白血症时的特殊反应[J]. 现代肿瘤医学, 2011, 19(6) : 1202-1206.

1. Gertz MA. Waldenstrom macroglobulinemia: 2015 update on diagnosis, risk stratification, and management[J]. Am J Hematol, 2015, 90(4) : 346-354.
2. Dimopoulos MA, Gertz MA, Kastritis E, et al. Update on treatment recommendations from the Fourth International Workshop on Waldenstrom’s macroglobulinemia[J]. J Clin Oncol, 2009, 27(1) : 120-126.
3. Iwanaga M, Yoshida Y, Tagawa M, et al. Waldenstrom’s macroglobulinemia in a 10-year stable IgG monoclonal gammopathy of undetermined significance[J]. Leuk Res, 2009, 33(1) : 193-195.
4. Polprasert C, Wongchitrat C, Assanasen T, et al. Lymphoplasmacytic lymphoma with IgA hypergammaglobulinemia and liver involvement[J]. J Med Assoc Thai, 2009, 92(Suppl 3) : S65-S68.
5. Castillo JJ, Ghobrial IM, Treon SP.Biology, prognosis, and therapy of Waldenstrom macroglobulinemia[J]. Cancer Treat Res, 2015(165) : 177-195.
6. Dimopoulos MA, Panayiotidis P, Moulopoulos LA, et al. Waldenstrom’s macroglobulinemia: clinical features, complications, and management[J]. J Clin Oncol, 2000, 18(1) : 214-226.
7. Takahashi K, Yamamura F, Motoyama H. IgM myeloma--its distinction from Waldenstrom’s macroglobulinemia[J]. Acta Pathol Jpn, 1986, 36(10) : 1553-1563.
8. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma[J]. Mayo Clin Proc, 2003, 78(1) : 21-33.
9. Owen RG, Treon SP, Al-Katib A, et al. Clinicopathological definition of Waldenstrom’s macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom’s Macroglobulinemia[J]. Semin Oncol, 2003, 30(2) : 110-115.
10. Owen RG, Pratt G, Auer RL, et al. Guidelines on the diagnosis and management of Waldenstrom macroglobulinaemia[J]. Br J Haematol, 2014, 165(3) : 316-333.
11. Treon SP. How I treat Waldenström macroglobulinemia[J]. Blood, 2015, 126(6) : 721-732.
12. Zelenetz AD, Gordon LI, Wierda WG, et al. Non-Hodgkin’s lymphomas, version 4.2014[J]. J Natl Compr Canc Netw, 2014, 12(9) : 1282-1303.
13. Reddy KR, Beavers KL, Hammond SP,et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy[J]. Gastroenterology, 2015, 148(1) : 215-219.
14. Izzedine H, Bourry E, Amrouche L, et al. Immunoglobulin M “Flare” after rituximab-associated acute tubular necrosis in Waldenström’s macroglobulinemia[J]. Int J Hematol, 2009, 89(2) : 218-222.
15. Noronha V, Fynan TM, Duffy T. Flare in neuropathy following rituximab therapy for Waldenstrom’s macroglobulinemia[J]. J Clin Oncol, 2006, 24(1) : e3.
16. 于亚平, 翟勇平, 史平, 等. 利妥昔单抗治疗华氏巨球蛋白血症时的特殊反应[J]. 现代肿瘤医学, 2011, 19(6) : 1202-1206.

West China Medical Journal

Waldenstrom Macroglobulinemia with Jaundice as the Initial Manifestation: A Report of One Case and Literature Review

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