Waldenstrom's macroglobulinemia is an uncommon low-grade lymphoproliferative malignancy that affects the elderly. It is characterized by infiltration of the bone marrow by plasmacytoid lymphocytes and high serum concentrations of IgM paraprotein. The disease causes hyperviscosity and coagulation defects, but responds well to cytotoxic therapy.

Williamson and colleagues suggest an occupational factor in Waldenstrom's macroglobulinemia, based on the observation of three cases in retired shoe repairers in England. Each of the three patients had worked for more than 40 years in the shoe repair business, which had exposed them to leather dust, rubber adhesives, shoe dyes and paint fumes. All of the men fulfilled the diagnostic criteria for Waldenstrom's macroglobulinemia. In each patient, coagulation abnormalities resolved following treatment with cyclophosphamide.

The expected incidence of Waldenstrom's macroglobulinemia in England is one case per 200,000 population per year. The three cases occurred in a population of 300,000, which is estimated to include approximately 20 retired shoe repairers.

Cancers of the bladder, rectum and paranasal sinuses are reported to be more common in workers involved in the manufacture of shoes and leather goods than in the general population. In addition, an increased incidence of perinatal loss has been reported in women in these industries. Solvents and glues used in the manufacture of these products have been implicated, but the identification of a cause-and-effect relationship is complicated by changes in the chemicals used in manufacturing over time.

The authors' observations suggest an association between Waldenstrom's macroglobulinemia and some type of occupational exposure in shoe repairers. A careful occupational history in new cases is recommended. (British Medical Journal, February 25, 1989, vol. 298, p. 498.)

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