학술논문
Simplified Risk Stratification Model for Patients With Waldenström Macroglobulinemia.
Document Type
Academic Journal
Author
Zanwar S; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Le-Rademacher J; Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.; Durot E; Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France.; D'Sa S; University College of London, London, United Kingdom.; Abeykoon JP; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Mondello P; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Kumar S; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Sarosiek S; Dana-Farber Cancer Institute, Boston, MA.; Paludo J; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Chhabra S; Division of Hematology, Mayo Clinic, Scottsdale, AZ.; Cook JM; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Parrondo R; Division of Hematology, Mayo Clinic, Jacksonville, FL.; Dispenzieri A; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Gonsalves WI; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Muchtar E; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Ailawadhi S; Division of Hematology, Mayo Clinic, Jacksonville, FL.; Kyle RA; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Rajkumar SV; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Delmer A; Department of Hematology, University Hospital of Reims and UFR Médecine, Reims, France.; Fonseca R; Division of Hematology, Mayo Clinic, Scottsdale, AZ.; Gertz MA; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Treon SP; Dana-Farber Cancer Institute, Boston, MA.; Ansell SM; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.; Castillo JJ; Dana-Farber Cancer Institute, Boston, MA.; Kapoor P; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
Source
Publisher: American Society of Clinical Oncology Country of Publication: United States NLM ID: 8309333 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-7755 (Electronic) Linking ISSN: 0732183X NLM ISO Abbreviation: J Clin Oncol Subsets: MEDLINE
Subject
Language
English
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.
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.