Ibrutinib is another agent that has been approved for use in this condition. Combination treatment with Ibrutinib and Rituximab showed significantly  higher disease progression free survival than with just Rituximab treatment.Autologous bone marrow transplantation is a treatment option.Zanubrutinib is indicated for the treatment of adults with Waldenström macroglobulinemia. Salvage therapy
When primary or secondary resistance invariably develops, salvage therapy is considered. Allogeneic stem cell transplantation can induce durable remissions for heavily pre-treated patients. Drug pipeline
As of October 2010, there have been a total of 44 clinical trials on Waldenström macroglobulinemia, excluding transplantation treatments. Of these, 11 were performed on previously untreated patients, 14 in patients with relapsed or refractory Waldenström. A database of clinical trials investigating Waldenström macroglobulinemia is maintained by the National Institutes of Health in the US. Patient stratification
Patients with polymorphic variants (alleles) FCGR3A-48 and -158 were associated with improved categorical responses to rituximab-based treatments. Prognosis
Current medical treatments result in survival of some longer than 10 years; in part this is because better diagnostic testing means early diagnosis and treatments. Older diagnosis and treatments resulted in published reports of median survival of approximately 5 years from time of diagnosis. Currently, median survival is 6.5 years. In rare instances, Waldenström macroglobulinemia progresses to multiple myeloma.The International Prognostic Scoring System for Waldenströms Macroglobulinemia is a predictive model to characterise long-term outcomes.
According to the model, factors predicting reduced survival are:

Age > 65 years
Hemoglobin ≤ 11.5 g/dL
Platelet count ≤ 100×109/L
B2-microglobulin > 3 mg/L
Serum monoclonal protein concentration > 70 g/LThe risk categories are:

Low: ≤ 1 adverse variable except age
Intermediate: 2 adverse characteristics or age > 65 years
High: > 2 adverse characteristicsFive-year survival rates for these categories are 87%, 68% and 36%, respectively. The corresponding median survival rates are 12, 8, and 3.5 years.The International Prognostic Scoring System for Waldenströms Macroglobulinemia has been shown to be reliable. It is also applicable to patients on a rituximab-based treatment regimen. An additional predictive factor is elevated serum lactate dehydrogenase (LDH). Epidemiology
Of cancers involving the lymphocytes, 1% of cases are Waldenström macroglobulinemia.Waldenström macroglobulinemia is a rare disorder, with fewer than 1,500 cases occurring in the United States annually. The median age of onset is between 60 and 65 years, with some cases occurring in late teens. History
Waldenström macroglobulinemia was first described by Jan G. Waldenström (1906–1996) in 1944 in two patients with bleeding from the nose and mouth, anemia, decreased levels of fibrinogen in the blood (hypofibrinogenemia), swollen lymph nodes, neoplastic plasma cells in bone marrow, and increased viscosity of the blood due to increased levels of a class of heavy proteins called macroglobulins.For a time, Waldenström macroglobulinemia was considered to be related to multiple myeloma because of the presence of monoclonal gammopathy and infiltration of the bone marrow and other organs by plasmacytoid lymphocytes.