Owen et al proposed criteria for the diagnosis of Waldenstrom's macroglobulinemia and identified prognostic factors associated with survival. The authors are from the General Infirmary at Leeds and the Bradford Royal Infirmary in England.


Criteria for the diagnosis of Waldenstrom's macroglobulinemia (see Table 5, page 427):

(1) IgM monoclonal gammopathy of any concentration

(2) bone marrow infiltration by lymphoid cells (small lymphocytes, plasmacytoid lymphocytes, plasma cells)

(3) bone marrow infiltration shows a diffuse, interstitial or nodular pattern

(4) immunophenotypic markers (in 90%):

(4a) positive: surface immunoglobulin, CD19, CD20

(4b) negative: CD5, CD10, CD23



• A paratrabecular pattern may be seen in Waldenstrom's macroglobulinemia but would be more typical for a follicular lymphoma. Biopsy of lymph node and/or PCR for t(14:18) may help diagnose the latter.


Adverse prognostic factors in multivariate analysis:

(1) age > 60 years

(2) WHO performance status >= 2 (see Chapter 1; range from mobile but unable to work to bedridden)

(3) platelet count < 100,000 per µL



(1) The International Prognostic Index had limited use for prognosis.

(2) IgM monoclonal gammopathy may be seen in all subtypes of peripheral B-cell disorders.


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