Watch and wait in Waldenström macroglobulinaemia: looking for who to watch carefully and who can wait without worrying. Is it that simple?

Observation is recommended for patients without immunoglobulin M (IgM)-related complications and/or symptoms related to bone marrow or extramedullary lymphoplasmacytic involvement.2 Asymptomatic IgM monoclonal gammopathy encompasses two clinicopathological entities with a distinct risk of progression to symptomatic WM: IgM monoclonal gammopathy of undetermined significance (IgM MGUS) and smouldering WM (SWM). In their paper, Zanwar I et al i .11 focussed on patients with SWM with the aim of identifying risk factors for early progression to symptomatic WM. Interestingly, they were able to identify a subset of patients (30% of patients with the two variables available) with a high risk of progression to symptomatic WM (median TTP 2-4 years). Zanwar I et al i .11 report that patients with SWM represent one-fifth of patients with WM. [Extracted from the article]