Progression risk stratification of asymptomatic Waldenström macroglobulinemia

Mark Bustoros, Romanos Sklavenitis-Pistofidis, Prashant Kapoor, Chia Jen Liu, Efstathios Kastritis, Saurabh Zanwar, Geoffrey Fell, Jithma P. Abeykoon, Kalvis Hornburg, Carl Jannes Neuse, Catherine R. Marinac, David Liu, Jenny Soiffer, Maria Gavriatopoulou, Cody Boehner, Joseph M. Cappuccio, Henry Dumke, Kaitlen Reyes, Robert J. Soiffer, Robert A. KyleSteven P. Treon, Jorge J. Castillo, Meletios A. Dimopoulos, Stephen M. Ansell, Lorenzo Trippa, Irene M. Ghobrial

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

BACKGROUND Waldenström macroglobulinemia (WM) is preceded by asymptomatic WM (AWM), for which the risk of progression to overt disease is not well defined. METHODS We studied 439 patients with AWM, who were diagnosed and observed at Dana-Farber Cancer Institute between 1992 and 2014. RESULTS During the 23-year study period, with a median follow-up of 7.8 years, 317 patients progressed to symptomatic WM (72%). Immunoglobulin M 4,500 mg/dL or greater, bone marrow lymphoplasmacytic infiltration 70% or greater, b2-microglobulin 4.0 mg/dL or greater, and albumin 3.5 g/dL or less were all identified as independent predictors of disease progression. To assess progression risk in patients with AWM, we trained and cross-validated a proportional hazards model using bone marrow infiltration, immunoglobulin M, albumin, and beta-2 microglobulin values as continuous measures. The model divided the cohort into three distinct risk groups: a high-risk group with a median time to progression (TTP) of 1.8 years, an intermediate-risk group with a median TTP of 4.8 years, and a low-risk group with a median TTP of 9.3 years. We validated this model in two external cohorts, demonstrating robustness and generalizability. For clinical applicability, we made the model available as a Web page application (www.awmrisk.com). By combining two cohorts, we were powered to identify wild type MYD88 as an independent predictor of progression (hazard ratio, 2.7). CONCLUSION This classification system is positioned to inform patient monitoring and care and, for the first time to our knowledge, to identify patients with high-risk AWM who may need closer follow-up or benefit from early intervention.

Original languageEnglish (US)
Pages (from-to)1403-1411
Number of pages9
JournalJournal of Clinical Oncology
Volume37
Issue number16
DOIs
StatePublished - 2019

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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