A case of Waldenström's macroglobulinemia treated using clarithromycin and prednisolone

Area of Science:

• Hematology
• Oncology

Background:

• Waldenström's macroglobulinemia (WM) is a rare lymphoproliferative disorder characterized by malignant lymphoplasmacytic cells in the bone marrow and the production of monoclonal IgM.
• Diagnosis of WM relies on bone marrow biopsy, detection of serum IgM M-protein, and exclusion of other conditions.

Observation:

• An 84-year-old woman presented with bleeding and hematuria, later diagnosed with WM.
• Computed tomography revealed an 'omental cake,' a rare manifestation of WM, and the patient exhibited bleeding tendencies possibly due to acquired hemophilia or platelet dysfunction.
• The patient was treated with clarithromycin (CAM) and prednisolone (PSL).

Findings:

• Treatment with clarithromycin and prednisolone resulted in a gradual decrease in serum IgM levels.
• The omental cake showed significant contraction, correlating with the reduction in IgM levels.
• These observations suggest the omental cake may represent a lymphoplasmacytic lymphoma-like manifestation.

Implications:

• This case suggests that a combination of clarithromycin and prednisolone can be an effective treatment option for select patients with Waldenström's macroglobulinemia.
• The findings highlight the potential therapeutic role of CAM and PSL in managing WM, particularly when associated with unusual presentations like an omental cake.
• Further research is warranted to explore the efficacy and safety of this treatment regimen in a larger cohort of WM patients.