Avoiding serious treatment-emergent adverse events in Waldenström macroglobulinemia patients

Waldenström's Macroglobulinemia is a rare chronic, incurable low-grade lymphoma with an increasing number of targeted agents available. Selecting efficacious treatment may reduce adverse events related to inadequate responses.

This review focusses on therapies in WM and management of adverse events. The role of genetic alterations (MYD88, CXCR4, TP53) and prognostic scores are discussed. Data pertaining to efficacy and adverse events are described alongside investigation for IgM-associated disorders.

Apparent treatment-emergent adverse events require particular attention, as these may be a manifestation of an IgM-associated disorder particularly systemic AL amyloidosis, IgM associated neuropathy or disease progression. Treatment 'failure' may be through resistance or dose-limiting toxicities. Post Bruton's tyrosine kinase inhibitors, novel therapies and combinations are being investigated. Ongoing work on issues of quality of life and patient reported outcomes will better inform our understanding of patient experience and should be reported in clinical trials.