Watchful waiting
In the absence of symptoms, many clinicians will recommend simply monitoring the patient; Waldenström himself stated "let well do" for such patients. These asymptomatic cases are now classified as two successively more pre-malignant phases, IgM monoclonal gammopathy of undetermined significance and smoldering Waldenström macroglobulinemia. But on occasion, the disease can be fatal, as it was to the French president Georges Pompidou, who died in office in 1974. Mohammad Reza Shah Pahlavi, the Shah of Iran, also had Waldenström macroglobulinemia, which resulted in his ill-fated trip to the United States for therapy in 1979, leading to the Iran hostage crisis. First-line
Should treatment be started it should address both the paraprotein level and the lymphocytic B-cells.In 2002, a panel at the International Workshop on Waldenströms Macroglobulinemia agreed on criteria for the initiation of therapy. They recommended starting therapy in patients with constitutional symptoms such as recurrent fever, night sweats, fatigue due to anemia, weight loss, progressive symptomatic lymphadenopathy or spleen enlargement, and anemia due to bone marrow infiltration. Complications such as hyperviscosity syndrome, symptomatic sensorimotor peripheral neuropathy, systemic amyloidosis, kidney failure, or symptomatic cryoglobulinemia were also suggested as indications for therapy.Treatment includes the monoclonal antibody rituximab, sometimes in combination with chemotherapeutic drugs such as chlorambucil, cyclophosphamide, or vincristine or with thalidomide. Corticosteroids, such as prednisone, may also be used in combination. Plasmapheresis can be used to treat the hyperviscosity syndrome by removing the paraprotein from the blood, although it does not address the underlying disease.
A 1919 paper entitled "Origin of the so-called auto-intoxication symptom" in the Journal of the American Medical Association marked the beginning of the rejection of the auto-intoxication hypothesis by the medical community.Despite a lack of scientific support, autointoxication persists in the public imagination. In the 1990s the practice of colon cleansing experienced a resurgence in the alternative-medical community, supported by testimonials and anecdotal evidence and promoted by manufacturers of colon-cleansing products. See also
Mucoid plaque
Whole bowel irrigation


== References ==