Each year, the US National Comprehensive Cancer Network (NCCN) publishes updated treatment guidelines for various forms of cancer, including Waldenstrom’s macroglobulinemia (WM). On September 16, 2015, the NCCN updated its guidelines for WM. The significant changes that are in this year’s guidelines are as follows:

• MYD88 L265P AS-PCR testing of bone marrow at diagnosis has been moved from “useful in certain circumstances” to “essential.” This means that, in addition to immunophenotyping, CBC, CMP, immunofixation/electrophoresis, serum viscosity, chest/abdominal/pelvic CT scan, bone marrow biopsy, and beta-2 microglobulin, MYD88 testing is now considered a necessary part of the diagnostic battery of tests.
• The IgM threshold for considering plasmapheresis before treatment with monoclonal antibodies (due to potential for “flaring”) has been lowered from 5,000 mg/dl to 4,000 mg/dl.

A link to the complete guidelines can be found on the IWMF website. Note: you must establish an account on the NCCN website to login and view the guidelines.

The NCCN is a not-for-profit alliance of 26 of the leading cancer centers in the US (including Dana-Farber Cancer Institute, Mayo Clinic, and MD Anderson Cancer Center). Its vision is to be the world’s leader in defining and advancing high-quality, high-value cancer care. See: http://www.nccn.org(link is external).