Waldenstrom's macroglobulinaemia is an uncommon condition seen in older men. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein

Features

• systemic upset: weight loss, lethargy
• hyperviscosity syndrome e.g. visual disturbance
  • the pentameric configuration of IgM increases serum viscosity
• hepatosplenomegaly
• lymphadenopathy
• cryoglobulinaemia e.g. Raynaud's

Investigations

• monoclonal IgM paraproteinaemia
• bone marrow biopsy is diagnostic
  • infiltration of the bone marrow with lymphoplasmacytoid lymphoma cells

Management

• typically rituximab-based combination chemotherapy