HEALINE

Model Predicts Progression Risk for Rare Type of Lymphoma

Model can improve monitoring of patients with asymptomatic Waldenström macroglobulinemia

FRIDAY, May 3, 2019 (Pharmacist's Briefing) -- A publicly available model can identify patients with asymptomatic Waldenström macroglobulinemia (AWM) at high risk for progression, according to a study published online April 16 in the Journal of Clinical Oncology.

Mark Bustoros, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues reviewed the cases of 439 patients with AWM, who were diagnosed and observed at a single institution between 1992 and 2014.

The researchers found that during a median follow-up of 7.8 years, 72 percent of patients progressed to symptomatic WM. Independent predictors of disease progression included: immunoglobulin M ≥4,500 mg/dL, bone marrow lymphoplasmacytic infiltration ≥70 percent, β2-microglobulin ≥4.0 mg/dL, and albumin ≤3.5 g/dL. Using a proportional hazards model with bone marrow infiltration, immunoglobulin M, albumin, and beta-2 microglobulin values as continuous measures, the model characterized patients by risk: 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. The model was validated in two external cohorts and demonstrated robustness and generalizability. When two cohorts were combined for greater power, wild-type MYD88 was identified as an independent predictor of progression (hazard ratio, 2.7).

"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," the authors write.

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