The prognosis for patients with Waldenstrom's macroglobulinemia can be estimated based on a small number of clinical parameters present at the time of diagnosis. This can help determine which patients may benefit from more or less aggressive therapy. The authors are from Northern Italy (Pavia, Varese, and Piacenza and Cremona).
Patient selection:
(1) Patients were previously untreated.
(2) Parameters were those present at the time of diagnosis.
(3) The authors stressed the importance in excluding patients with MGUS from the study set, since this group would have a better survival and thereby bias the findings.
Parameters identified with multivariate analysis:
(1) age
(2) change in weight
(3) hemoglobin
(4) cryoglobulinemia
Other factors identified in univariate analysis:
(1) platelet count (< or >= 120,000 per µL)
(2) red blood cells in urine (no or increased numbers)
(3) erythrocyte sedimentation rate (< or >= 110 mm in first hour)
|
Parameter |
Finding |
Points |
|
age of patient |
< 70 years |
0 |
|
|
>= 70 years |
1 |
|
weight |
stable or gain |
0 |
|
|
loss of 3 kg or more during prior 6 months |
1 |
|
hemoglobin |
>= 9 g/dL |
0 |
|
|
< 9 g/dL |
1 |
|
cryoglobulinemia |
absent |
0 |
|
|
present |
1 |
prognostic score =
= SUM(points for the 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
|
Score |
Risk Group |
Median Survival |
10 year survival |
|
0 or 1 |
Better |
84 months |
38% |
|
2, 3 or 4 |
Worse |
52 months |
17% |
using data in Figure 2, page 2942
The patients were also analyzed using 60 as the discriminant age.
|
Age |
Other Risk Factors |
Median Survival |
10 year survival |
|
<= 60 |
0 or 1 |
84 months |
30% |
|
|
2 or 3 |
48 months |
18% |
|
> 60 |
0 |
136 months |
80% |
|
|
1, 2 or 3 |
46 months |
5% |
using data in Figure 4, page 2943
Limitations:
• The article is somewhat confusing in its dealing with age, first identifying 70 years as a key age then switching discussion to 60 years (presumably for comparison with the study of Facon et al in J Clin Oncol 1993; 11: 1553). This still leaves patients 60-70 years of age in a sort of limbo.
• The survival curves for the better prognostic group show precipitous drops after 120 months, which could reflect older patients dying of unrelated causes.
• On page 2941 column 2, referring to Figure 4: "patients with no more than one unfavorable factor (of the 3 remaining after the exclusion of age) clearly did worse than the other 49 with at least 2 unfavorable parameters." Figure 4 shows the exact opposite.
Specialty: Hematology Oncology
