Clinical, Laboratory, and Bone Marrow Findings of 31 Patients With Waldenström Macroglobulinemia

Ann Lab Med. 2020 May;40(3):193-200. doi: 10.3343/alm.2020.40.3.193.


Background: Waldenström macroglobulinemia (WM) is a subset of lymphoplasmacytic lymphoma (LPL) with bone marrow (BM) involvement and an IgM monoclonal gammopathy of any level. We aimed to identify the clinical, laboratory, and BM findings of patients with WM and to evaluate the usefulness of CD154 for the diagnosis and prognosis of WM.

Methods: We reviewed the medical records and BM studies and/or flow cytometric immunotyping of 31 patients with untreated WM. Semiquantitative immunohistochemistry (CD20, CD138, tryptase, and CD154) of BM was performed.

Results: Only six patients presented with symptoms of hyperviscosity syndrome. Eleven patients had solid cancer and/or another hematologic malignancy. Mast cells (MC) increased in all samples, with some in close contact with tumor cells. Tryptase-positive MC (17.1/ high-power fields [HPF], 1.2-72.0/HPF) and CD154-positive MC (8.6/HPF, 0.1-31.1/HPF) were observed. The high CD154-positive MC (≥8.6/HPF) group showed a lower overall five-year survival rate than the low CD154-positive MC (<8.6/HPF) group (71.9% vs. 100.0%; P=0.012). Flow cytometric immunophenotyping of BM aspirates showed increased B lymphocytes and plasma cells with a normal phenotype (CD138⁺/CD38⁺/CD19⁺/CD45⁺/CD56⁻).

Conclusions: Approximately one third of WM patients showed other malignancies and all patients had increased MC. Immunohistochemistry and flow cytometric immunophenotyping are useful for diagnosing WM, and increased CD154-positive MC can indicate poor prognosis.

Keywords: CD154; Mast cell; Monoclonal gammopathy; Waldenström macroglobulinemia.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antigens, CD20 / metabolism
  • B-Lymphocytes / cytology
  • B-Lymphocytes / metabolism
  • Bone Marrow / metabolism
  • Bone Marrow / pathology*
  • CD40 Ligand / metabolism
  • Diagnosis, Differential
  • Flow Cytometry / methods
  • Humans
  • Immunophenotyping
  • Kaplan-Meier Estimate
  • Mast Cells / cytology
  • Mast Cells / metabolism
  • Middle Aged
  • Paraproteinemias / complications
  • Paraproteinemias / diagnosis
  • Plasma Cells / cytology
  • Plasma Cells / metabolism
  • Retrospective Studies
  • Waldenstrom Macroglobulinemia / complications
  • Waldenstrom Macroglobulinemia / diagnosis*
  • Waldenstrom Macroglobulinemia / mortality


  • Antigens, CD20
  • CD40 Ligand