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In rare cases, Waldenstrom’s macroglobulinaemia can change (or transform) into a faster-growing, or high-grade, form of lymphoma. It’s important to remember that WM doesn’t transform in most people. However, it is good to be aware of the symptoms so that you can get a quick diagnosis and receive treatment.
Waldenstrom’s macroglobulinaemia is known as an ‘indolent’ or ‘low-grade’ form of lymphoma. This means that it is slow growing. Waldenstrom’s macroglobulinaemia is one of many different types of low-grade lymphomas which may not need treatment for some time, if at all. If you do require treatment, most people have periods of remission (when cancer cells can’t be found) and some will later relapse (when cancer cells start growing again).
High-grade lymphomas on the other hand are faster-growing and might be referred to as ‘aggressive’ lymphomas because of this. High grade lymphomas often need treatment straightaway. Most people who are diagnosed with a high-grade lymphoma are treated successfully and stay in remission.
Very rarely, a low-grade lymphoma can change (or transform) into a high-grade lymphoma, meaning the cells change from slower-growing into faster-growing ones. In most cases, WM will transform into a type of high-grade lymphoma called diffuse large B-cell lymphoma (DLBCL), but it can transform into other types of high-grade lymphoma too.
Transformation can happen at any time – it might be found at diagnosis with WM, or it may happen many years afterwards.
If you’re diagnosed with a high-grade lymphoma, it doesn’t mean your WM has disappeared but that you have aggressive lymphoma cells in your body alongside your low-grade WM.
It’s unlikely that your Waldenstrom’s macroglobulinaemia will have transformed if you haven’t experienced any symptoms. Your clinician will check for any evidence of transformation at your check-ups.
The key symptoms to look out for are:
These symptoms can also be linked to WM, and don’t necessarily mean that your WM has transformed. However, it’s important to tell your healthcare team about these symptoms straightaway if you experience them, as getting an early diagnosis and treatment is important
High-grade lymphoma is treatable. Your treatment will depend on many factors including:
If fit, most people are offered a chemotherapy regimen known as R-CHOP. This contains five drugs: rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone. It is a more intense regimen than those you would normally receive for WM alone.
Just like with WM, there isn’t a ‘one size fits all’ treatment, and what works for you might not be the same for others. Your clinician will discuss the different options that are suitable for your unique circumstances.
You can read more on our chemotherapy page.
If you need a second course of treatment, your clinician may consider other chemotherapy regimens. Another option is a stem cell transplant, but this treatment is more intensive and isn’t suitable for everyone. Alternatively, your doctor may suggest you join a clinical trial for the type of lymphoma you have.
Most people can be treated successfully and go into remission, meaning that there isn’t any evidence of the high-grade lymphoma in their body after treatment.
It’s best to talk to your healthcare team about your own individual outlook, as they will know your personal history and circumstances – something that general statistics don’t take into account.
After treatment, your doctor will monitor you closely with regular check-ups and blood tests to ensure your high-grade lymphoma has not relapsed, meaning that the high-grade cells start growing again. If this happens, you’ll be offered further treatment.
The short answer is: we don’t know yet.
We know that in some people, there are fast-growing cells in amongst the slow-growing Waldenstrom’s macroglobulinaemia cells. Sometimes these ‘take-over’ and transform the slow-growing WM into a high-grade lymphoma. In other people, the low-grade cells physically change into high-grade ones.
Scientists are looking at why this happens, and if there is anything that might help doctors see if someone is more at risk of their low-grade lymphoma transforming into something that is faster growing.
