Chemotherapy for Waldenstrom Macroglobulinemia

Chemotherapy (chemo) uses anti-cancer drugs that are taken by mouth, or injected into a vein, a muscle, or under the skin. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment very useful for Waldenstrom macroglobulinemia (WM).

Chemo is given in cycles. A period of treatment is followed by a rest period to allow the body time to recover. Each chemo cycle generally lasts for several weeks. Most chemo treatments are given on an outpatient basis (in the doctor’s office, clinic, or hospital outpatient department).

Many types of chemo drugs can be used to treat patients with WM:

Alkylating agents

• Cyclophosphamide (Cytoxan^®)
• Bendamustine (Treanda^®)

Purine analogs

• Fludarabine (Fludara^®)
• Cladribine (2-CdA, Leustatin^®)

Corticosteroids

• Prednisone
• Dexamethasone (Decadron^®)

Other chemo drugs

• Vincristine (Oncovin^®)
• Doxorubicin (Adriamycin^®)

Chemo drugs may be used alone or combined with other drugs, such as targeted drugs or immunotherapy drugs. (For a list of some common combinations used in WM, see When to Treat People With Waldenstrom Macroglobulinemia.)

Chemo side effects

Chemo drugs attack cells that are dividing quickly, which is why they work against WM cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to certain side effects.

The side effects of chemo depend on which drugs are used, the doses, and the length of time they are taken. Common side effects include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• Diarrhea or constipation
• Increased risk of infections (from having too few white blood cells)
• Problems with bleeding or bruising (from having too few blood platelets)
• Fatigue (tiredness) and shortness of breath (from having too few red blood cells)

Other side effects can be seen with certain drugs. For example, doxorubicin can damage the heart. Corticosteroid drugs can cause problems sleeping and an increased appetite.

If you have side effects, your cancer care team can suggest steps to ease them. For example, medicines can be taken to help prevent and control nausea and vomiting. Most side effects are temporary and go away after treatment is finished. If you have serious side effects, the chemo may have to be reduced or stopped, at least temporarily.

Long-term side effects of chemotherapy

Some chemo drugs cause long-term side effects that can affect almost any part of the body. One of the most serious complications with certain chemo drugs is the possibility of developing leukemia later on. It affects a very small percentage of patients, but it is more common in patients who take fludarabine or alkylating agents.