[Waldenström's macroglobulinemia]

Waldenström's macroglobulinemia associates a serum monoclonal IgM and a lymphoplasmacytic infiltration of bone marrow, spleen, lymph nodes and various organs. Clinical symptoms are related either to the lymphoid disorder or to the physico-chemical characteristics or antibody activity of the monoclonal IgM. Visceral infiltration may target stomach small bowel, lungs, exocrine glands or skin. Major complications include bone marrow failure, auto-immune cytopenia, occurrence of large cell lymphoma and infections (related either to the humoral immunodeficiency or to chemotherapy). Asymptomatic macroglobulinemia does not deserve any treatment. Otherwise, alkylating agents or nucleoside analogues are first line agents. The benefit of monoclonal antibodies, high dose chemotherapy followed by auto or allogenic stem cell graft is currently assessed.