Waldenstrom Macroglobulinemia Staging 

Updated: Dec 31, 2015
  • Author: Joseph M Tuscano, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Diagnostic Studies

Recommended diagnostic studies to evaluate a suspected diagnosis of Waldenstrom macroglobulinemia/lymphoplasmacytic lymphoma are as follows [1] :

  • History and physical examination with complete neurologic and ophthalmologic examination
  • Quantitative serum immunoglobulin G, immunoglobulin A, and immunoglobulin M (IgM) (total levels of serum immunoglobulins should be assessed with nephelometry)
  • Serum immunofixation
  • Twenty-four–hour urine collection for protein electrophoresis
  • Serum free light-chain assay
  • Bone marrow biopsy with cytogenetics, fluorescence in situ hybridization (FISH) (for lymphoma and myeloma), and flow cytometry (should include CD19, CD20, CD38, and CD138)
  • CT scanning of the chest, abdomen, and pelvis (to assess for lymphadenopathy and splenomegaly)
  • Complete blood cell (CBC) count and serum chemistries
  • Serum viscosity
  • Autoantibodies, Coombs test, cold agglutinins, cryoglobulins, anti–myelin-associated glycoprotein (MAG) antibodies (based on history and physical finding)

Staging/Prognostic Scoring System for Waldenstrom Macroglobulinemia/Lymphoplasmacytic Lymphoma

Each of the following positive prognostic factors is assigned a value of one, with the final sum used to assess prognostic score and predicted survival: [2]

  • IgM level >7 g/dL
  • Age >65 years
  • Hemoglobin level ≤11.5 g/dL
  • Platelet count ≤100,000/µL
  • Beta2-microglobulin level >3 µg/mL

The sum is then used to estimate prognosis and survival (see Table 1).

Table 1. Assessment of Prognostic Score and Predicted Survival (Open Table in a new window)

Score Stratum Median Survival (mo)
0-1a Low 142
2b Intermediate 96
>2 High 43
a Except age.



b Age >65 years is also intermediate risk.