Prognostic model for disease-specific and overall mortality in newly diagnosed symptomatic patients with Waldenstrom macroglobulinaemia.
We sought to define prognostic factors for survival in Waldenstrom macroglobulinaemia (WM). Of 585 patients diagnosed with WM and seen at Mayo Clinic between 1960 and 2001, 337 symptomatic patients met the inclusion criteria and were analysed for overall and disease-specific survival. The median survival from the time of diagnosis was 6.4 years. The median disease-specific survival was 11.2 years. Univariate analysis for overall survival identified the following adverse prognostic factors: age >65 years (P < 0.001), organomegaly (P < 0.001), elevated beta2-microglobulin (<0.001), anaemia (Hb < 10.0 g/dl) (P = 0.01), leucopenia (<4.0 x 10(9)/l) (P = 0.03), thrombocytopenia (<150 x 10(9)/l) (P = 0.01), serum albumin <40 g/l (P = 0.001), and quantitative IgM < 0.4 g/l (P = 0.04). On multivariate analysis, age >65 years and organomegaly were associated with poor prognosis. A prognostic model was built based on these two variables. Patients at high risk (1-2 risk factors, median survival 4.2 years) experienced worse survival than patients at low risk (0 risk factors, median survival 10.6 years), P < 0.001. The prognostic model was validated in 204 patients who were not included in the analysis cohort. Beta2-microglobulin > or =4 mg/l was associated with a threefold increase in the risk of death when added to the prognostic model. We describe a simple prognostic model for overall survival for newly diagnosed patients with WM.
Ghobrial
Irene M
IM
Division of Hematology, Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Fonseca
Rafael
R
Gertz
Morie A
MA
Plevak
Matthew F
MF
Larson
Dirk R
DR
Therneau
Terry M
TM
Wolf
Robert C
RC
Hoffmann
Randi J
RJ
Lust
John A
JA
Witzig
Thomas E
TE
Lacy
Martha Q
MQ
Dispenzieri
Angela
A
Vincent Rajkumar
S
S
Zeldenrust
Stephen R
SR
Greipp
Philip R
PR
Kyle
Robert A
RA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis* / Q000401:mortality; D001613:beta 2-Microglobulin / Q000097:blood
D015415:Biomarkers; D001613:beta 2-Microglobulin