Congress Abstracts 2006

117

WALDENSTROM'S MACROGLOBULINEMIA: WHAT IT IS, HOW TO TREAT IT, AND THE NURSE'S ROLE. Tiffany Richards, MS, ANP, AOCNP, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Waldenstrom's macroglobulinemia (WM) is a low grade lymphoplasmacytic malignancy characterized by bone marrow infiltration of lymphoplasmacytic cells that produce a monoclonal immunoglobulin M (IgM). Approximately 1,500 patients in the United States are diagnosed annually with WM. While approximately 25% of patients present with asymptomatic disease, the majority requires treatment for signs or symptoms (anemia, bulky adenopathy, splenomegaly, high monoclonal protein >5g/dL, or hyperviscosity). It is imperative that nurses are knowledgeable about Waldenstrom's in order to educate patients/families about the disease, identify potential complications, and provide symptom management.

Clinical manifestations may result from increased cell growth or overproduction of the monoclonal IgM. Symptoms indicative of treatment include, anemia, the presence of B-symptoms, hyperviscosity, organomegaly, bulky lymphadenopathy, neuropathy, or the development of associated complications, such as cryoglobulinemia, amyloidosis, or hemolysis. The development of hyperviscosity may require plasmapheresis prior to initiating systemic therapy if visual disturbances such as retinal hemorrhages and/or neurological impairment are present.

Systemic treatment involves combinations of alkylating agents, nucleoside analogs, and monoclonal antibodies, which will be discussed. While plasmapheresis does not reduce tumor burden, it reduces the serum IgM level by 35% and provides temporary symptom management until systemic chemotherapy is initiated.

Nearly 100 previously untreated patients at our center received cladribine alone or in combination with other agents, (cyclophosphamide and/or rituximab). Over 90% of patients achieved partial response after only 2 courses given six weeks apart followed without further therapy until time of relapse.

Nursing has the opportunity to impact outcomes for individuals with WM. Patient/family education regarding the disease and clinical manifestations to report is essential so that patients can seek medical attention promptly when symptoms arise. Since treatment for macroglobulinemia is usually outpatient, education about symptom management can improve the patients overall wellbeing.

This presentation will (1) discuss a brief overview of the pathogenesis, clinical features, and treatment of Waldenström's (2) complications associated with macroglobulinemia such as hyperviscosity, cold agglutinin anemia, amyloidosis, and cryoglobulinemia, and (3) define nursing's role in assessment and treatment.