Lymphomas
Waldenström macroglobulinemia
If you or someone you love has just heard this diagnosis, start here. This guide explains what the condition is, how it is usually treated and whether a transplant plays any part.
Waldenström macroglobulinemia is a lymphoplasmacytic lymphoma that produces an IgM antibody protein. Some people need only monitoring; medicines are the usual treatment, with transplantation reserved for selected relapsed disease.
Other names and abbreviations
LPL, IgM-LPL/WM, WM, Waldenström macroglobulinaemia, lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia, IgM-lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia type, non-WM-type lymphoplasmacytic lymphoma
In short
- Waldenström macroglobulinemia is a lymphoma that usually involves the bone marrow. It makes an antibody protein called IgM.
- Some people need only monitoring. When treatment is needed, the usual medicines include antibody combinations or BTK inhibitors.
- Transplant is not a routine first treatment. If the disease returns, some people may have one using their own cells. Donor transplants are much less common.
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Underlined words open a short explanation. See all terms
Where transplant fits
TransplantA treatment that gives a patient healthy blood-forming stem cells through a vein. The cells travel to the bone marrow and replace faulty marrow or marrow damaged by treatment. They can come from the patient or a donor. is not routine first-line treatment. Autologous rescueComing from the patient's own body. In an autologous transplant, the patient's own stem cells are collected and stored, then given back after high-dose treatment. It does not use a donor. can be used in selected responsive relapsedWhen a disease comes back after a period of getting better. Relapsed disease has returned after treatment helped for a time. disease; allogeneicComing from another person. In an allogeneic, or donor, transplant, the stem cells come from a relative or an unrelated volunteer whose cells are a close enough match to the patient's. donor transplantation is much less common.
Treatment depends on the exact diagnosis, disease stage, prior treatment and the person’s health.
Key facts
- Who it affects
- Waldenström macroglobulinemia mainly affects older adults and is more common in men.
- How common
- About 1,000 to 1,500 new cases a year (about 3 per million people a year)United States, American Cancer Society estimate (revised November 2025) Source: How common
- Cells used in a transplant
- The patient’s own collected cells for autologous rescue; donated blood-forming cells only when an allogeneic procedure is selected.
- Where a donor fits
- Limited transplant role
The condition
What it is
The abnormal B-cellA type of white blood cell that makes antibodies. B cells are part of the immune system and grow from stem cells in the bone marrow. Some lymphomas and leukemias start in B cells. population has features of both lymphocytes and plasma cells and usually involves the marrowThe soft, spongy tissue in the center of most bones. Red bone marrow holds the blood-forming stem cells that make red blood cells, white blood cells and platelets.. The IgM protein it makes can cause problems in addition to the cells themselves.
An IgM protein alone does not establish Waldenström macroglobulinemia. Marrow findings and other tests distinguish it from IgM MGUS and other disorders. MYD88 and CXCR4 mutation testing can help characterize the disease and inform treatment.
Marked as affected: B cells and plasma cells.
- Blood stem cell, In the bone marrow
- Myeloid line
- Red blood cells
- Platelets
- Granulocytes
- Monocytes
- Lymphoid line
- B cells, Affected
- Plasma cells, Affected, Develop from B cells
- T cells
- NK cells, Natural killer cells
- Myeloid line
What causes it
Acquired changes in B-cell growth and signaling contribute to the lymphoma. A MYD88 mutation is common but is not present in every case and is not a diagnosis by itself.
The disease mainly affects older adults. Some familial clustering is recognized, but the cause in an individual is usually unknown. It is not contagious.
Symptoms and effects
Marrow involvement can cause anemia and fatigue. Enlarged lymph nodes or spleen, weight loss and night sweats may occur.
IgM can thicken the blood, causing hyperviscosity with headache, blurred vision or bleeding. It can also contribute to neuropathy, cold-related circulation problems or immune destruction of blood cells. Which effects are present matters more than treating an IgM number in isolation.
A simple drawing of a body. Often affected: bone marrow. Can also be affected: eyes, spleen, lymph nodes, nerves and blood vessels.
Often affected
- Bone marrow: can cause anemia
Can also be affected
- Eyes: blurred vision when the blood is too thick
- Spleen
- Lymph nodes
- Nerves: nerve damage
- Blood vessels: blood flow problems in the cold
This shows the parts of the body the condition can affect. Most people have only some of these, and the drawing says nothing about how severe any of them will be.
Diagnosis and treatment
How Waldenström macroglobulinemia is diagnosed
Waldenström macroglobulinemia (WM) grows slowly. Some people have no symptoms. It is found during blood work done for another reason. A blood doctor (hematologist) or cancer doctor (oncologist) then orders more tests. A complete blood count checks red cells, white cells and platelets. Other tests measure antibodyA protein made by the immune system that sticks to one specific target, such as a germ. Some wrongly target the body's own tissues. Lab-made antibody medicines can target markers such as CD20 or CD38 on some cancer cells. (immunoglobulin) levels. Two protein tests, serum protein electrophoresis and immunofixation, show whether the extra antibody is IgM.
Other blood tests measure how thick the blood is (serum viscosity) and a protein called beta-2 microglobulin. A urine test can look for pieces of IgM that the kidneys remove.
A bone marrow aspiration and biopsy is needed to confirm the diagnosis. WM is confirmed by an IgM protein plus at least 10% abnormal lymphoplasmacytic cells in the marrow. A lab test of the cells' surface proteins (flow cytometry) helps identify them. Testing for MYD88 and CXCR4 gene changes is recommended. A MYD88 change is found in more than 90% of people with WM, but it is not required for the diagnosis.
CT or PET scans look for signs of lymphoma in the chest, belly and pelvis. The U.S. National Cancer Institute also says people with this lymphoma should be checked for hepatitis C.
An IgM protein on its own is not WM. The marrow findings help tell WM apart from a related condition called IgM MGUS.
How it is treated
People without symptoms or organ problems may be monitored. When treatment is needed, options include anti-CD20-based combinations, BTK inhibitors and other selected systemic therapiesAffecting the whole body. Systemic treatment uses medicines that travel through the blood to reach cells all over the body.. Prior treatment, mutation profile, comorbidities and patient preferences affect the choice.
Symptomatic hyperviscosity may need urgent plasma exchange to remove circulating IgM. This helps the immediate problem but does not eliminate the marrow clone, so disease-directed treatment is usually also required.
Autologous transplantation can be an option for selected fit patients with responsive relapsed disease, but is not standard first-line care. Allogeneic transplantation is much less common because treatment-related risks must be weighed against several effective non-transplant options.
Kinds of treatment described for Waldenström macroglobulinemia: watching and regular checks (for some people), supportive care, medicines, a donor stem cell transplant (for a few people) and a transplant with the person’s own cells (for some people).
After diagnosis, the options described here
Watching and regular checks, For some people
Some people need only monitoring until the disease causes problems.
Supportive care
Thick blood may need urgent plasma exchange to remove IgM, which helps right away but does not treat the marrow.
Medicines
When treatment is needed, the usual medicines include antibody combinations or BTK inhibitors.
Donor stem cell transplant, For a few people
Donor transplants are much less common and may be considered for some younger people whose disease keeps returning.
Transplant with the person’s own cells, For some people
If the disease returns, some people may have a transplant using their own cells.
These are the kinds of treatment this page describes, not a plan. Which ones fit, in what order and whether they are combined differs from person to person.
When transplant specialists are usually consulted
A transplant is not part of first treatment for WM. EBMT's 2025 recommendations list a transplant with a person's own cells as an option when WM comes back and responds to treatment again. A donor transplant may be considered for some younger people with many relapses, short-lived responses, or disease that resists treatment.
Read the guidanceDaily life and the donor’s role
Living with the condition and treatment
Care may involve long periods of observation, ongoing oral treatment or scheduled drug cycles. Fatigue and neuropathy can affect daily life even when the lymphoma changes slowly.
The team can explain which new symptoms might indicate hyperviscosity or another complication and when to seek prompt help. Treatment monitoring may include blood counts, IgM, infection risk and regimen-specific effects.
The role of a blood stem cell donor
Most people with Waldenström macroglobulinemia do not need a registry donor. Plasma exchange, ordinary transfusionsPutting blood, or parts of blood such as red cells or platelets, into a person's bloodstream through a vein. Some people with blood disorders need regular transfusions. and autologous stem cell rescue are different procedures from an allogeneic transplant.
A suitable donor is relevant only if allogeneic transplantation is selected in an uncommon clinical situation. Joining a registry supports patients who need donated cells across many diseases, rather than being the usual next step for this condition.
Looking ahead
Looking ahead
Outlook for Waldenström macroglobulinemia
WM usually grows slowly, and many people live with it for years. The average age at diagnosis is 70. A 2025 expert review notes that most people with WM die of causes unrelated to it.
Doctors estimate risk with a few measures. These include age, albumin, hemoglobin, plateletTiny pieces of cells in the blood that help form clots to slow or stop bleeding. They are made in the bone marrow. Too few platelets can cause easy bruising and bleeding. count, beta-2 microglobulin, LDH and the IgM level. Rarely, WM changes into a fast-growing lymphoma called diffuse large B-cell lymphoma. In a large U.S. study, this happened in about 2 in 100 people within 10 years. When it happened, survival was shorter.
Survival figures come from people diagnosed years ago. The American Cancer Society notes that changes in treatment since then may mean a better outlook for people diagnosed today. No figure can predict how one person will do.
About these numbers. Each one says which group of people it comes from, and the place and years where the source gives them. It describes what happened across that group, not what will happen to any one person. And a figure measured among people who had a transplant is not the same as the number of people who need one.
- About 78%5-year relative survival
People diagnosed with WM in 2001–2010, U.S. SEER database of the National Cancer Institute (as reported by the American Cancer Society, revised November 2025)
Read the source: 5-year relative survival - 119 months (about 10 years)Median overall survival
8,191 adults diagnosed with WM or lymphoplasmacytic lymphoma in 2000–2020 (median age 70), U.S. SEER registries; counts deaths from all causes (published 2025)
Read the source: Median overall survival
Relative survival compares people with WM with people in the overall population. These are group averages, not a forecast for any one person.
Common questions
Is Waldenström macroglobulinemia a type of cancer?
Yes. Waldenström macroglobulinemia is a slow-growing (indolent) type of non-Hodgkin lymphoma. Doctors classify it as a lymphoplasmacytic lymphoma. The cancer cells have features of both B cells and plasma cells. They build up mostly in the bone marrow and make large amounts of an antibody protein called IgM. Too much IgM can thicken the blood. Because it grows slowly, it can be many years before some people notice any signs.
What is the life expectancy with Waldenström macroglobulinemia?
Many people live with it for years. The average age at diagnosis is 70, and a 2025 expert review notes that most people with WM die of other causes. Age, blood counts, albumin, beta-2 microglobulin and LDH help doctors estimate risk. The outlook section on this page gives the figures, with the groups they describe. No figure can predict one person's outcome.
Does Waldenström macroglobulinemia always need treatment right away?
No. The American Cancer Society says not everyone with WM needs treatment right away. People without serious or bothersome symptoms can often be watched closely. This early stage without symptoms is sometimes called smoldering WM. Treatment usually starts when the disease causes problems. These include low blood counts such as anemia, fevers, night sweats or weight loss, thick blood (hyperviscosity), nerve damage (neuropathy), or swollen lymph nodes or organs that cause symptoms.
Is Waldenström macroglobulinemia hereditary?
Usually not. MedlinePlus Genetics says WM is not inherited, and most people with it have no family history of it. It comes from gene changes in blood cells that happen during a person's life, such as a change in the MYD88 gene. Some families do seem to be more prone to it. About 20% of people with WM have a relative with WM or another disorder of B cells.
Can Waldenström macroglobulinemia be cured?
Usually not with current treatment, but it can often be controlled for a long time. The U.S. National Cancer Institute says slow-growing lymphomas, the group WM belongs to, are usually not curable at advanced stages. It also says people can often be treated again with good results when the disease comes back. Treatments include antibody combinations and BTK inhibitors. Keeping side effects low is an important part of choosing treatment.
Does Waldenström macroglobulinemia need a stem cell transplant?
Usually not. Most people are treated with medicines. European transplant guidance (EBMT, 2025) says a transplant with a person's own cells should not be a first treatment. It may be an option when the disease comes back and responds to treatment again. A donor transplant is much less common. It may be considered for some younger people whose disease keeps coming back or resists treatment. Most people with WM do not need a registry donor.
For your next appointment
Waldenström macroglobulinemia
From the Jada Bascom Foundation disease library, jadabascomfoundation.org. Printed .
Questions to bring to your care team
- Do I need treatment now, or can we watch and wait? Which symptoms or test changes would mean it is time to start?
- What did my MYD88 and CXCR4 tests show, and how do they affect the medicine you suggest?
- Which signs of thick blood (hyperviscosity) should send me for urgent care?
- If a transplant with my own cells might be an option later, does that change which treatments you would use now?
- What is the exact name of the diagnosis or subtype, and what does it mean for treatment?
- What is the goal of each treatment you are suggesting?
- Are there clinical trials that might fit?
- Where can our family find support during treatment?
A one-page list to take to the next appointment, with room for notes.
Supporting someone with a diagnosisSupport for patients and families
These independent organizations offer information and support. JBF is not affiliated with them.
- International Waldenstrom's Macroglobulinemia Foundation (IWMF) Nonprofit for Waldenström macroglobulinemia offering US and international support groups, one-on-one LIFELINE support, caregiver help and online discussion forums.Worldwide (based in the United States)
- WMUK UK charity for Waldenström macroglobulinemia offering a free support line with a WM-expert nurse, support groups and plain-language information.United Kingdom
- Lymphoma Research Foundation US nonprofit devoted to lymphoma, offering a helpline, patient guides, peer support, webinars and financial support resources for patients and caregivers.United States
Sources and further reading
- Indolent B-Cell Non-Hodgkin Lymphoma Treatment (PDQ), Health Professional Version
NCI, Accessed 2026-09-05 - WHO fifth-edition classification: Lymphoid Neoplasms
WHO classification authors / Leukemia, Accessed 2026-09-05 - Indications for haematopoietic cell transplantation and CAR-T: 2025 EBMT practice recommendations
EBMT / Bone Marrow Transplantation, Accessed 2026-09-05 - Stem Cell and Bone Marrow Transplants for Cancer
NCI, Accessed 2026-09-05 - Tests for Waldenstrom Macroglobulinemia
American Cancer Society, Revised 2025-11-17; accessed 2026-09-26 - Key Statistics About Waldenstrom Macroglobulinemia
American Cancer Society, Revised 2025-11-17; accessed 2026-09-26 - Survival Rates for Waldenstrom Macroglobulinemia
American Cancer Society, Revised 2025-11-17; accessed 2026-09-26 - Treating Waldenstrom Macroglobulinemia
American Cancer Society, Revised 2025-11-20; accessed 2026-09-26 - Waldenström macroglobulinemia
MedlinePlus Genetics, U.S. National Library of Medicine, Updated 2021-09-24; accessed 2026-09-26 - Waldenström Macroglobulinemia: 2025 Update on Diagnosis, Risk Stratification, and Management (abstract)
American Journal of Hematology (Gertz MA), 2025; accessed 2026-09-26 - Transformation and survival in patients with Waldenström macroglobulinemia: a population-based study
Discover Oncology (Du Y, et al.), 2025-11-21; accessed 2026-09-26
This information explains a condition and its treatments. It cannot diagnose an illness or recommend treatment for an individual. Your care team can explain how the evidence applies to you. Written and source-checked by the Jada Bascom Foundation. Each page lists the published sources it draws on.
Ways to help
Help another family understand.
Most people with Waldenström macroglobulinemia are treated without a registry donor. A clear explanation can help the next family who hears this diagnosis, and many people with other blood cancers and blood disorders need a donor who is a stranger.
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Part of 3 diagnosis guides, each explaining how its subtypes fit together: Non-Hodgkin lymphoma (NHL), Lymphoma and Types of blood cancer.
