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Waldenström Macroglobulinaemia (WM) is an indolent, non-Hodgkin B-cell lymphoma characterised by lymphoplasmacytic infiltration of the bone marrow together with a monoclonal IgM paraprotein in the blood. It predominantly affects older adults and follows a chronic, relapsing course.

Clinical features stem from marrow failure and high IgM levels, including fatigue from anaemia, bruising or bleeding due to thrombocytopenia, hepatosplenomegaly, lymphadenopathy, and hyperviscosity syndrome (blurred vision, headache, neurological deficits). Diagnosis requires ?10% clonal lymphoplasmacytic cells in marrow plus serum IgM monoclonal protein, after excluding other small B cell lymphomas.

Asymptomatic patients may undergo watchful waiting, while symptomatic disease warrants therapy. First line options include chemoimmunotherapy (e.g., bendamustine-rituximab, cyclophosphamide-dexamethasone-rituximab), proteasome inhibitor-based regimens, and BTK inhibitors such as ibrutinib. Plasmapheresis provides rapid relief in hyperviscosity. Although incurable, many patients achieve durable responses and prolonged survival with appropriate monitoring and treatment.