American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of chemotherapy regimen may be used for treating Waldenström macroglobulinemia?

1. Only antimetabolites

2. An alkylating agent base or purine analog base

3. Nuclear factor kappa B inhibitors

4. Proteasome inhibitors

The correct answer is: An alkylating agent base or purine analog base

The treatment of Waldenström macroglobulinemia often involves the use of chemotherapy regimens that feature an alkylating agent base or purine analog base. These classes of drugs are particularly effective because they target the abnormal B-cell proliferation that characterizes this condition. Alkylating agents, such as cyclophosphamide, disrupt the DNA of rapidly dividing cells, thereby reducing tumor burden. Purine analogs like fludarabine also play a significant role in targeting lymphoid malignancies by interfering with DNA synthesis and promoting apoptosis in neoplastic cells. The rationale for employing these agents lies in their ability to address the underlying pathology of Waldenström macroglobulinemia, which is primarily characterized by the excessive production of immunoglobulin M (IgM) by malignant B cells. Achieving a reduction in the population of these B cells can diminish symptom severity and overall disease burden. Other options, while they may have potential roles in the management of various hematological malignancies, do not specifically align with the established treatment regimens for Waldenström macroglobulinemia. For instance, nuclear factor kappa B inhibitors and proteasome inhibitors are more commonly associated with other conditions such as multiple myeloma, but they do not