Prognostic markers and criteria to initiate therapy in Waldenstrom's macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom's Macroglobulinemia.
This presentation represents consensus recommendations on prognostic markers and criteria to initiate therapy in patients with Waldenstrom's macroglobulinemia (WM), which were prepared in conjunction with the Second International Workshop held in Athens, Greece during September 2002. The panel recommended that initiation of therapy should not be based on the IgM level per se since this may not correlate with the clinical manifestations of WM. The consensus panel agreed that initiation of therapy was appropriate for patients with constitutional symptoms such as recurrent fever, night sweats, fatigue due to anemia, or weight loss. The presence of progressive, symptomatic lymphadenopathy or splenomegaly provide additional reasons to begin therapy. The presence of anemia with a hemoglobin value of <or= 10 g/dL or a platelet count < 100 x 10(9)/L due to marrow infiltration also justifies treatment. Certain complications such as hyperviscosity syndrome, symptomatic sensorimotor peripheral neuropathy, systemic amyloidosis, renal insufficiency, or symptomatic cryoglobulinemia may also be indications for therapy. Recommendations for follow-up of watch-and-wait patients are that those with monoclonal gammopathy of undetermined significance (MGUS) should have serum protein electrophoresis repeated each year. Patients with asymptomatic (smoldering) macroglobulinemia should be evaluated every 6 months. Regarding prognostic markers, hemoglobin and beta(2)-microglobulin levels at diagnosis are important prognostic markers in WM: they influence the timing of treatment and survival. Age is a consistently important prognostic factor for survival. However, the panel felt that current data are inadequate to support the use of any prognostic marker to select the timing and type of therapy, and called for studies on the application of prognostic markers in WM.
Kyle
Robert A
RA
Mayo Clinic, Rochester, MN, USA.
Treon
Steven P
SP
Alexanian
Raymond
R
Barlogie
Bart
B
Björkholm
Magnus
M
Dhodapkar
Madhav
M
Lister
T Andrew
TA
Merlini
Giampaolo
G
Morel
Pierre
P
Stone
Marvin
M
Branagan
Andrew R
AR
Leblond
Véronique
V
D000367:Age Factors; D000740:Anemia; D015415:Biomarkers / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007075:Immunoglobulin M / Q000378:metabolism; D008206:Lymphatic Diseases; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013163:Splenomegaly; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015431:Weight Loss; D001613:beta 2-Microglobulin / Q000378:metabolism
D015415:Biomarkers; D006454:Hemoglobins; D007075:Immunoglobulin M; D001613:beta 2-Microglobulin