中華民國血液病學會

1. Which symptoms could be hyperviscosity related?
(1) Seizures. (4) Vertigo.
(2) Chest pain or Shortness of breath. (5) Heart or kidney failure.
(3) Hearing problems.

A. 2,3,4

B. 1,2,3,5

C. 1,2,3,4

D. 1,2,3,4,5

2. Which statement is better recommendation? 71-year-old male patient, with history of stage IV diffuse large B cell lymphoma diagnosed in 2007, completing six cycles of rituximab plus cyclophosphamide, etoposide, vincristine, prednisone (R-CEOP). This patient attended the clinic for regular follow-up in 2021. He started to complain vertigo, several syncope episodes, and recurrent chest tightness. He was confirmed diagnosed as WM with IgG / IgA / IgM: 873 / 140 / 7040 (mg/dL).

A. Considering age, initial treatment with rituximab monotherapy is recommended.

B. According to NCCN guidelines, BR (bendamustine+rituximab) could be the initial treatment for this patients.

C. Considering high IgM level with hyperviscosity symptoms, plasma exchange should be performed before BR (bendamustine+rituximab) treatment.

D. All above correct.

3. Which statement is false?

A. According to previous study, the occurrence of symptomatic hyperviscosity does not impact the overall survival.

B. Based on results of univariate and multivariate model analyses, the most predictable factors for symptomatic hyperviscosity are serum viscosity and serum IgM level (>6,000 mg/dL)

C. Plasmapheresis should be considered before treatment with Rituximab in WM patients with IgM>3000 mg/dL according to NCCN guidance.

D. Cardiovascular symptoms may occur in hyperviscosity syndrome.