Diagnosis
The diagnosis requires an IgM monoclonal protein plus bone marrow infiltration by lymphoplasmacytic lymphoma. MYD88 L265P testing is helpful, and other IgM-producing conditions such as multiple myeloma and other lymphomas must be excluded.
Blood counts, immunoglobulin levels, viscosity and organ involvement are reviewed. Some patients are diagnosed incidentally and remain stable for years.
Related: Haematology → · Dr. Sachita Baniya profile → · All conditions →
When treatment is needed
Treatment is considered for symptomatic anaemia, thrombocytopenia, bulky lymphadenopathy or splenomegaly, hyperviscosity, symptomatic neuropathy, amyloidosis or other IgM-related complications. Asymptomatic patients are usually monitored.
Hyperviscosity can cause headaches, blurred vision, dizziness, confusion or bleeding and needs urgent assessment. Plasmapheresis may be used to lower IgM quickly in severe cases.
- Symptoms of hyperviscosity
- Progressive anaemia or thrombocytopenia
- Enlarged nodes, spleen or liver
- Neuropathy or amyloid-related organ damage
Treatment options
Treatment may include rituximab-based regimens, BTK inhibitors such as ibrutinib, or other targeted combinations. The choice depends on symptoms, cytopenias, IgM level, comorbidities and patient preference.
Response is monitored with IgM, blood counts, symptoms and organ function. Patients with hyperviscosity need urgent coordination with transfusion or apheresis services.
Access and booking
Dr. Baniya consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre. Bring all blood counts, marrow, flow cytometry and molecular reports.