Signs and Symptoms of Waldenstrom Macroglobulinemia

Sometimes, Waldenstrom macroglobulinemia (WM) isn’t causing any symptoms when it’s first found. Instead, it’s found when the person has blood tests done for some other reason. WM found this way is sometimes called asymptomatic or smoldering WM.

When WM does cause symptoms, some of them can be like those seen with other types of non-Hodgkin lymphoma (NHL). For example, weight loss, fever, night sweats, and swollen lymph nodes can be seen in many types of NHL.

Other WM symptoms are caused by the large amounts of abnormal IgM antibody (M protein) made by the cancer cells:

• In hyperviscosity syndrome, too much of the M protein in the blood can cause it to become too “thick.” (This is not the kind of thickness that can be treated with drugs known as blood thinners.) When the blood gets too thick, it has trouble moving through blood vessels. This can cause problems such as poor circulation to the brain, which can lead to symptoms like those from a stroke.
• If the M protein only thickens the blood in cooler parts of the body (like in the tip of the nose, ears, fingers, and toes), it is called a cryoglobulin. Cryoglobulins can cause pain or other problems in these areas if a person is exposed to cooler temperatures.
• A condition called amyloidosis can occur when a part of the IgM antibody (called the light chain) builds up in organs like the heart and kidneys. This buildup can lead to heart and kidney problems.

Not all people with WM develop hyperviscosity, cryoglobulins, or amyloidosis.

Common symptoms of WM

Weakness: This is one of the most common symptoms of WM. It can be caused by anemia (too few red blood cells), which can happen when the WM cells crowd out normal cells in the bone marrow. Some people also feel weak when the blood thickens from the buildup of the abnormal protein.

Loss of appetite: Some people with WM lose their appetite.

Fever, sweats, weight loss: WM, like other lymphomas, can cause fevers (without an infection), drenching night sweats, and weight loss (without trying). These are called B symptoms.

Neuropathy: In some people with WM, the abnormal antibody can attack and damage nerves outside the brain. This can lead to numbness or a painful “pins and needles” sensation in the feet and legs, which is called neuropathy.

Less common signs and symptoms of WM

Enlarged lymph nodes: These usually appear as lumps under the skin around the neck, in the groin, or in the armpits. Enlarged lymph nodes are usually about 1 or 2 inches (2.5-5 cm) across. They are seen less often in WM than in most other lymphomas.

Swollen abdomen (belly): WM can sometimes make the spleen or liver bigger, making the belly look swollen. In the upper part of the abdomen, the liver is on the right and the spleen on the left. When the spleen gets larger, it can press on the stomach, which makes people feel full when they eat even a small amount.

Circulation system symptoms: In hyperviscosity syndrome, the thickened blood causes poor brain circulation, leading to problems like headache, confusion, and dizziness. It can also cause symptoms like those seen with a stroke, including slurred speech and weakness on one side of the body. Patients with these symptoms should contact their doctor right away.

Abnormal bleeding: High levels of abnormal antibody can damage blood vessels, which can lead to problems like nosebleeds and bleeding gums.

Vision problems: Bleeding around the small blood vessels inside the eyes or poor circulation in these vessels caused by thickened blood might lead to blurred vision or blind spots.

Kidney problems: High levels of the M protein can damage the kidneys directly or through the development of amyloidosis. When the kidneys don’t work well, excess salt, fluid, and body waste products stay in the blood. This can cause symptoms like weakness, trouble breathing, and fluid buildup in body tissues.

Heart problems: High levels of the M protein can damage heart tissue directly or through the development of amyloidosis, in which the protein builds up in the heart muscle. This weakens the heart, affecting its ability to pump blood. In addition, because the blood of people with WM is thicker than normal, their hearts have to work harder to pump blood throughout the body. This strain can wear down the heart muscle, leading to a condition called congestive heart failure. Symptoms can include heart palpitations, feeling tired and weak, cough, shortness of breath, rapid weight gain, and swelling in the feet and legs.

Infections: The high levels of abnormal antibody in WM can slow the body’s normal antibody production. This makes it harder for the body to fight infections.

Digestive symptoms: In some people with WM, the buildup of the M protein in the intestines can lead to problems such as diarrhea, poor absorption of vitamins, or gastrointestinal bleeding (seen as blood in the stools or dark stools).

Sensitivity to cold: In people with cryoglobulins, exposure to cold temperatures can lead to pain, itching, a bluish color, or even sores on the tip of the nose, ears, fingers, or toes due to reduced blood flow to these areas.