Simplified Risk Stratification Model for Patients With Waldenström Macroglobulinemia
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Published:2024-07-20
Issue:21
Volume:42
Page:2527-2536
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Zanwar Saurabh1ORCID, Le-Rademacher Jennifer2ORCID, Durot Eric3ORCID, D’Sa Shirley4, Abeykoon Jithma P.1ORCID, Mondello Patrizia1ORCID, Kumar Shaji1ORCID, Sarosiek Shayna5ORCID, Paludo Jonas1ORCID, Chhabra Saurabh6, Cook Joselle M.1, Parrondo Ricardo7ORCID, Dispenzieri Angela1ORCID, Gonsalves Wilson I.1, Muchtar Eli1ORCID, Ailawadhi Sikandar7ORCID, Kyle Robert A.1ORCID, Rajkumar S. Vincent1, Delmer Alain3ORCID, Fonseca Rafael6, Gertz Morie A.1ORCID, Treon Steven P.5ORCID, Ansell Stephen M.1ORCID, Castillo Jorge J.5ORCID, Kapoor Prashant1ORCID
Affiliation:
1. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 2. Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 3. Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France 4. University College of London, London, United Kingdom 5. Dana-Farber Cancer Institute, Boston, MA 6. Division of Hematology, Mayo Clinic, Scottsdale, AZ 7. Division of Hematology, Mayo Clinic, Jacksonville, FL
Abstract
PURPOSE Patients with Waldenström macroglobulinemia (WM) have disparate outcomes. Newer therapies have emerged since the development of International Prognostic Scoring System, and MYD88 L265P mutation is now frequently assessed at diagnosis, warranting reexamination of the prognostic parameters. PATIENTS AND METHODS We reviewed records of 889 treatment-naïve patients with active WM, consecutively seen between January 01, 1996, and December 31, 2017, to identify clinical predictors of overall survival (OS) in univariate analyses. Patients with complete data for the parameters significant on the univariate analyses (n = 341) were included in a multivariable analysis to derive a prognostic model, subsequently validated in a multi-institutional cohort. RESULTS In the derivation cohort (n = 341), age (hazard ratio [HR], 1.9 [95% CI, 1.2 to 2.1]; P = .0009), serum lactate dehydrogenase (LDH) above upper limit of normal (HR, 2.3 [95% CI, 1.3 to 4.5]; P = .007), and serum albumin <3.5 g/dL (HR, 1.5 [95% CI, 0.99 to 2.3]; P = .056) were independently prognostic. By assigning a score of 1 point each to albumin <3.5 g/dL (HR, 1.5) and age 66-75 years (HR 1.4) and 2 points for age >75 years (HR, 2.6) or elevated LDH (HR, 2.3), four groups with distinct outcomes were observed on the basis of the composite scores. Five-year OS was 93% for the low-risk (score 0), 82% for low-intermediate risk (score 1), 69% for intermediate-risk (score 2), and 55% for the high-risk (score ≥3; P < .0001) groups. In the validation cohort (N = 335), the model maintained its prognostic value, with a 5-year OS of 93%, 90%, 75%, and 57% for the four groups, respectively ( P < .0001). CONCLUSION 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 WM into four groups with distinct prognosis.
Publisher
American Society of Clinical Oncology (ASCO)
Cited by
1 articles.
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