Our Unique Approach

The Bing Center for Waldenström's Macroglobulinemia is part of Dana-Farber Brigham Cancer Center's Center for Hematologic Oncology, one of the world's largest and most respected treatment centers for patients with disorders of the blood or bone marrow. Hematological disorders can take many different forms, and your care team here includes experts with specialized knowledge in treating various manifestations of Waldenström's.

The Bing Center for WM cares for more than 1000 patients a year. With over 20 years focused on WM, our experts are skilled in creating a carefully timed care plan that works for each patient, minimizing side effects and enhancing your quality of life. We offer the most advanced treatments, including clinical trials. Many of these therapies were developed by scientists in our own laboratories.

Multidisciplinary Team

Our physicians, hematologists/oncologists, physician assistants, nurse practitioners, nurses, laboratory investigators, clinical care coordinators, clinical social workers, and nutritionists work closely together to decide what kind of treatment – if any is needed – will work best to combat your particular disease at each stage.

Our Waldenström's Tumor Board meets weekly to discuss every case. These specialists review your care plan to reach a consensus recommendation, which we share with you. Your team works to ensure that your care plan offers the best possible outcomes, and that all your personal needs are met.

Personalized Treatment

As a highly specialized Center within Dana-Farber Brigham Cancer Center's Center for Hematologic Oncology, we focus on the distinct needs of people with Waldenström's. We provide a very personalized approach to your care. If you are likely to have a specific side effect from a treatment that will interfere with your life or plans, we take care to tailor your therapy to keep your quality of life at the center of the treatment plan.

A distinguishing area of our expertise is in the treatment of adults over 60 years, who often have different needs from younger adults. For example, they may have a higher risk for heart disease, diabetes, or kidney problems, which influence the choice of treatment options. To address the specific needs of these patients, we offer clinical trials specifically for adults 60 years and over.

Our physician-scientists' investigations into the genetic underpinnings of Waldenström's are paving the way for treatment approaches based in personalized medicine. We have numerous Waldenström's-related clinical trials currently underway testing novel, targeted drugs.

We view every patient as an individual, with unique needs and expectations. We take time to involve you and your family in each step of the treatment process. As you go through treatment, you will have access to a wide range of resources – from nutritional services to integrative therapies – that we provide to support you and your family.

Offering Expertise through Second Opinions

We believe there is value in patients with suspected or diagnosed Waldenström's receiving a second opinion. We routinely evaluate specimens sent to us from outside centers. These specimens are evaluated by our entire team, including our expert hematopathologists.

Waldenström's can be difficult to diagnose and properly treat. Reasons to consider a second opinion include:

•   To confirm your diagnosis.
•   If you have received a diagnosis and want to be treated at Dana-Farber Brigham Cancer Center.
•   To determine the optimal therapy, and whether any is needed at this time.
•   To learn more about your cancer from specialists who are world leaders in this disease, and who have treated hundreds of other patients like you.
•   To learn if you're eligible for a clinical trial.

Phone: 877-442-DFCI or 877-442-3324
Online: Complete the Appointment Request Form

If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service.

For Referring Physicians

Because you, the referring physician, are an integral part of your patient's care team, we are committed to collaborating with you to provide the best care for your patient.

If you are a physician and have a patient with diagnosed or suspected Waldenström's, we look forward to working with you. Learn how to refer a patient.

Treatments for Waldenström's

Each patient's care combines the finest treatments currently available for Waldenström's with innovative new therapies based on research discovered through our own laboratories. For newly diagnosed patients and for patients whose disease has relapsed, your care team will carefully consider every approach, including clinical trials evaluating new therapies.

Certain factors affect your treatment options:

•   Your age.
•   Your general health.
•   Your levels of Immunoglobulin M (IgM), the presence of low blood counts, the need for disease control, whether you have low-risk disease or high-risk disease, and the chance of associated health problems.
•   Your lifestyle and goals.

Treatment Approaches can include:

Watchful waiting

We take a strategic and thoughtful approach to treatment that considers your quality of life and goals for treatment. If you are asymptomatic or have precancerous Smoldering Waldenstrom's Macroglobulinemia (SWM) or Monoclonal Gammopathy of Undetermined Significance (MGUS), you may not need treatment right away and can be monitored regularly for disease progression.

The main reason to consider watchful waiting is to avoid the side effects of treatment. We make every effort to ensure that the potential side effects from your therapy impact your life, hobbies, work, and interests as little as possible. Certain treatments may also heighten the risk of contracting secondary leukemia in the future. We are careful to factor this into treatment plans, especially for younger patients.

Initial Treatment Approaches for WM

When treatment is needed, we take into account the patient’s main presenting problems related to WM, the genomics of their WM cells, and their physical condition. As WM is incurable with present treatment approaches, we seek to develop new treatments for WM and will also consider a patient’s eligibility and offer state of the art clinical trial options. Our standard, non-clinical trial options may include chemo-immunotherapy using bendamustine and rituximab, or targeted therapies such as a BTK-inhibitor like ibrutinib or zanubrutinib. For patients presenting with WM related amyloidosis, large lymph nodes or spleen or with a mass, or with peripheral or central nervous system disease, we will customize treatment to address specific needs of the patient. Rarely patients with WM will also present with disease transformation to an aggressive lymphoma, and we will seek to validate such a presentation before making a treatment decision. In all our discussions, we seek to inform the patient and accompanying family of the treatment options available, including clinical trials, and to provide pro/cons and our input for best treatment approach.

Approach to the WM patient with Relapsed or Refractory Disease

In some cases, the initial treatment approach to WM will not work. This is called refractory disease. As well, most patients with WM will require re-treatment after they experience a remission. Thisis called relapsed disease. Relapses can occur years or even decades later and vary considerably. Fortunately, there are a large and expanding number of effective treatment options available, and you will have the opportunity to speak with physician about which regimen is most appropriate for you. Clinical trial options for refractory or relapsed WM disease are usually available, and your eligibility for these traisl will also be discussed. Treatment decisions will take into account factors such as the type of treatment you have received in the past, the success of prior treatments for your condition, side effects that you have experienced, genomic mutations in your WM cells, and your preferences for the type of treatment you'd like to receive.

Once treatment starts for relapsed disease, you will be monitored closely for evidence that the treatment is working. Adjustments are made to enhance its effectiveness and how well you tolerate therapy. Under certain circumstances, therapy could be stopped and you may be observed without treatment.

Breakthrough Research Informs Breakthrough Treatments

Our scientists are working to understand the genetic basis and pathogenesis of WM and are developing therapies. By establishing a registry with thousands of patients and their family members, our program has gained important insights into the genetic basis of the disease. These revelations have also helped establish the importance of certain signaling pathways that permit survival of WM cells, and resistance to drug therapies. These scientific advances have resulted in clinical trials and led to the development and adoption of many treatments for WM, including the approval of BTK-inhibitors for WM.

New directions in treatment

Some of the new agents being tested in clinical trials being investigated at the Bing Center for WM include covalent (ibrutinib, zanubrutinib, acalabrutinib) and non-covalent (pirtobrutinib) BTK-inhibitors, BTK-degraders, BCL-2 inhibitors (venetoclax), CXCR4 inhibitors (ulocuplomab, mavorixafor) and immune based therapies that include antibodies conjugated to payloads that kill tumor cells, and bi-specific antibodies that stimulate immune T-cells to kill WM cells. Combination studies using these agents are also being investigated.

Consensus Panel Reports

The following consensus panel reports from the 11th International Workshop on Waldenstrom's Macroglobulinemia contain the latest information on treatment options. These consensus panels are updated every 2 years, coinciding with the Workshops on WM.

Report of Consensus Panel 1: Management of Symptomatic, Treatment-Naïve Patients:
https://www.sciencedirect.com/science/article/abs/pii/S0037196323000264

Report of Consensus Panel 2: Management of Relapsed or Refractory WM Patients:
https://www.sciencedirect.com/science/article/abs/pii/S0037196323000252

Report of Consensus Panel 3: Recommendations for molecular diagnosis in Waldenström's Macroglobulinemia:
https://www.sciencedirect.com/science/article/pii/S0037196323000276#bib0016

Report of Consensus Panel 4: Diagnostic and Response Criteria:
https://www.sciencedirect.com/science/article/pii/S0037196323000379

Report of Consensus Panel 5: COVID-19 Prophylaxis and Management:
https://www.sciencedirect.com/science/article/pii/S0037196323000240

Report of Consensus Panel 6: Management of Waldenström's Macroglobulinemia Related Amyloidosis:
https://www.sciencedirect.com/science/article/abs/pii/S0037196323000227

Report of Consensus Panel 7: Priorities for Novel Clinical Trials.: Clinical Trial Priorities for WM:
https://www.sciencedirect.com/science/article/abs/pii/S0037196323000239