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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.

Written and source-checked by the Jada Bascom FoundationSources checked Editorial standards

In-depth guide
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 choices are rituximab with chemotherapy or a BTK inhibitor such as zanubrutinib.
  • 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.
Jump to a section

Underlined words open a short explanation. See all terms

Where transplant fits

is not part of first treatment. A transplant with the person’s own can be used for some people whose disease comes back and responds again; a 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 person’s own stem cells for an autologous transplant; stem cells from a donor only when a donor transplant is chosen.
Where a donor fits
Limited transplant role

The condition

What it is

The abnormal cells are with features of both lymphocytes and plasma cells, and they usually build up in the . They make an IgM protein, which can cause problems of its own.

An IgM protein alone does not mean Waldenström macroglobulinemia. Bone marrow findings and other tests tell it apart from IgM MGUS (an IgM protein without lymphoma) and other disorders. Tests for changes in the MYD88 and CXCR4 genes help describe the disease and guide treatment.

Where Waldenström macroglobulinemia starts in the bloodThe abnormal cells in Waldenström macroglobulinemia are B cells with features of plasma cells, and they make an IgM antibody protein.Simplified illustration.

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

What causes it

Gene changes gained during life, not inherited, alter how the B cells grow and signal. A change in the MYD88 gene is found in more than 90% of people with WM, but not in everyone, and it does not make the diagnosis on its own.

The disease mainly affects older adults. Some families have more than one affected member, but the cause in any one person 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. Doctors decide on treatment from these effects, not from the IgM level alone.

Where Waldenström macroglobulinemia can affect the bodyThis lymphoma usually involves the bone marrow, and the IgM protein it makes can also affect nerves, eyes and blood flow.Simplified illustration.

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 antibody (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 watched closely without treatment. When treatment is needed, common choices are the antibody rituximab combined with chemotherapy such as bendamustine, or a daily BTK inhibitor pill such as zanubrutinib or ibrutinib. Other medicines, such as bortezomib, venetoclax and pirtobrutinib, have shown activity when the disease comes back. The choice depends on earlier treatment, the MYD88 and CXCR4 results, other health problems and the person’s preferences.

Symptomatic hyperviscosity may need urgent plasma exchange to remove circulating IgM. This helps right away but does not treat the lymphoma cells in the marrow, so other treatment is usually needed too.

A transplant using the person’s own stem cells () can be an option for some fit people whose disease comes back and responds to treatment again. It is not part of first treatment. A donor (allogeneic) transplant is much less common: its risks are high and other treatments work well, so European guidelines suggest it only for some younger people with several .

How Waldenström macroglobulinemia can be treatedMedicines are the usual treatment, some people need only monitoring and a transplant is kept for some people whose disease returns.Simplified illustration.

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 choices are rituximab with chemotherapy or a BTK inhibitor such as zanubrutinib.

  • 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 guidance

Daily 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. Checks during treatment may include blood counts, the IgM level, infection risk and the side effects of the specific medicines.

The role of a blood stem cell donor

Most people with Waldenström macroglobulinemia do not need a registry donor. Plasma exchange, blood and a transplant of a person’s own stem cells do not need a donor match.

A donor is needed only if a donor (allogeneic) transplant is chosen, which is uncommon in WM. Joining a registry helps patients with many diseases who do need donated cells.

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, 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 rituximab with chemotherapy 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.

How a transplant using your own cells works

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.

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Sources and further reading

  1. Indolent B-Cell Non-Hodgkin Lymphoma Treatment (PDQ), Health Professional Version
    NCI, Accessed 2026-11-13
  2. WHO fifth-edition classification: Lymphoid Neoplasms
    WHO classification authors / Leukemia, Accessed 2026-11-13
  3. Indications for haematopoietic cell transplantation and CAR-T: 2025 EBMT practice recommendations
    EBMT / Bone Marrow Transplantation, Accessed 2026-11-13
  4. Stem Cell and Bone Marrow Transplants for Cancer
    NCI, Accessed 2026-11-13
  5. Tests for Waldenstrom Macroglobulinemia
    American Cancer Society, Revised 2025-11-17; accessed 2026-11-13
  6. Key Statistics About Waldenstrom Macroglobulinemia
    American Cancer Society, Revised 2025-11-17; accessed 2026-11-13
  7. Survival Rates for Waldenstrom Macroglobulinemia
    American Cancer Society, Revised 2025-11-17; accessed 2026-11-13
  8. Treating Waldenstrom Macroglobulinemia
    American Cancer Society, Revised 2025-11-20; accessed 2026-11-13
  9. Waldenström macroglobulinemia
    MedlinePlus Genetics, U.S. National Library of Medicine, Updated 2021-09-24; accessed 2026-11-13
  10. Waldenström Macroglobulinemia: 2025 Update on Diagnosis, Risk Stratification, and Management (abstract)
    American Journal of Hematology (Gertz MA), 2025; accessed 2026-11-13
  11. Transformation and survival in patients with Waldenström macroglobulinemia: a population-based study
    Discover Oncology (Du Y, et al.), 2025-11-21; accessed 2026-11-13

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.

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