New Risk Stratification Model for Waldenström’s Macroglobulinemia

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As reported in the Journal of Clinical Oncology, Zanwar et al developed a prognostic model for overall survival in patients with Waldenström’s macroglobulinemia based on age, albumin level, and lactate dehydrogenase (LDH) level.

Study Details

In the study, data from 889 consecutive treatment-naive patients with active Waldenström’s macroglobulinemia seen between January 1996 and December 2017 at Mayo Clinic, Rochester, were used to identify clinical predictors of overall survival in univariate analyses. The derivation cohort consisted of 341 of these patients with complete data on factors significant on univariate analyses, who were included in a multivariate analysis to derive a prognostic model; the model was then validated in a multi-institutional cohort of 335 patients.

Key Findings

In the derivation cohort, patient age (hazard ratio [HR] = 1.9, 95% confidence interval [CI] = 1.2–2.1, P = .0009), serum LDH level above the upper limit of normal (HR = 2.3, 95% CI = 1.3–4.5, P = .007), and serum albumin level measuring less than 3.5 g/dL (HR = 1.5, 95% CI = 0.99–2.3, P = .056) were independently prognostic of overall survival. In the model, one point each was assigned to albumin less than 3.5 g/dL and patient age of 66 to 75, and two points each were assigned for age older than 75 and elevated LDH level, with four groups that had distinct outcomes being identified on the basis of composite scores: 5-year overall survival was 93% in the low-risk (score = 0), 82% in the low-intermediate risk (score = 1), 69% in the intermediate-risk (score = 2), and 55% in the high-risk groups (score ≥ 3; overall P < .0001).

The model maintained its prognostic value in the validation cohort, with 5-year overall survival rates of 93%, 90%, 75%, and 57%, respectively, in the low-risk, low-intermediate risk, intermediate-risk, and high-risk groups (overall P < .0001).

The investigators concluded: “[The] Modified Staging System for WM (MSS-WM), utilizing age, albumin, and LDH, is a simple, clinically useful, and externally validated prognostic model that reliably risk-stratifies patients with symptomatic Waldenström’s macroglobulinemia into four groups with distinct prognosis.”

Prashant Kapoor, MD, of the Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, is the corresponding author of the Journal of Clinical Oncology article.

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