Serum levels of macrophage inflammatory protein-1 alpha (MIP-1alpha) and bone remodelling markers were evaluated in 38 patients with Waldenström macroglobulinaemia (WM) and correlated with clinical and laboratory variables. MIP-1alpha was elevated in WM; untreated patients had higher MIP-1alpha levels than patients in remission or with active disease after treatment. MIP-1alpha correlated with increased bone resorption, beta2-microglobulin and splenomegaly. Receptor activator of nuclear factor-kappaB ligand serum levels were elevated in WM patients; the subsequent increased bone resorption was balanced by a comparable elevation of osteoprotegerin production and bone formation. These findings may explain the absence of lytic lesions in WM patients and suggest a potential role of MIP-1alpha in WM.