Waldenström’s macroglobulinemia: Report of two cases

Abstract

          Waldenstr๖m’s macroglobulinemia (WM) is a clonal neoplastic disease of the lymphoplasmacytic cell. The diagnostic criteria consist of lymphoplasmacytic cells more than 20 % in the bone marrow and monoclonal gammopathyIgM> 3 g%. It is a very rare disease of the senior age group worldwide as well as in Thailand. And herein, we reported two additional Thai patients. Both were males, ages were 58 and 82 years. Both had no complaint except for fatigue due to anemia. Their physical examination revealed no lymphadenopathy, no hepatosplenomegaly. Their blood tests were: Hb 7.7 and 6.6 g%, serum globulin 8.2 and 7.4 g%. With theimmunofixation method, themonoclonal gammopathyIgM, kappa type in the first and lambda type in the second case were demonstrated. The lymphoplasmacytic cells more than 20 % were found in the bone marrow both. No lytic lesion was seen in the bone survey. They were diagnosed as WM. Because of anemia, they were treated with oral cyclophosphamide on alternate day, besides blood transfusion. They could survive more than 2 years after the diagnosis while the anemia was gradually improved during the follow-up period. Other differential diagnosis of our cases was multiple myeloma or MM, IgM monoclonal gammopathy type because of the kidney impairment. Due to lack of the lytic bone lesion that was the important characteristic of MM, it was hardly possible to diagnose MM.

                                                ผู้ป่วย WM ของเราทั้งสองราย นอกจากจะมีภาวะโลหิตจางแล้วมีเงื่อนงำเดียวที่พอช่วยให้นึกถึงโรคนี้ได้ คือการที่ระดับ globulin ในเลือดสูงขึ้นอย่างชัดเจน Both WM patients may result in only anemic symptomas in our cases, no organomegaly, its definite diagnosis could be delayedor even hardly possible if the clinician did not have adequate realization.