Τίτλος:
Progression risk stratification of asymptomatic Waldenström macroglobulinemia
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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. © 2019 by American Society of Clinical Oncology
Συγγραφείς:
Bustoros, M.
Sklavenitis-Pistofidis, R.
Kapoor, P.
Liu, C.-J.
Kastritis, E.
Zanwar, S.
Fell, G.
Abeykoon, J.P.
Hornburg, K.
Neuse, C.J.
Marinac, C.R.
Liu, D.
Soiffer, J.
Gavriatopoulou, M.
Boehner, C.
Cappuccio, J.M.
Dumke, H.
Reyes, K.
Soiffer, R.J.
Kyle, R.A.
Treon, S.P.
Castillo, J.J.
Dimopoulos, M.A.
Ansell, S.M.
Trippa, L.
Ghobrial, I.M.
Περιοδικό:
Journal of Clinical Oncology
Εκδότης:
American Society of Clinical Oncology
Λέξεις-κλειδιά:
albumin; beta 2 microglobulin; creatinine; hemoglobin; immunoglobulin kappa chain; immunoglobulin lambda chain; immunoglobulin M; lactate dehydrogenase; M protein; myeloid differentiation factor 88; ALB protein, human; beta 2 microglobulin; biological marker; human serum albumin; immunoglobulin M; MYD88 protein, human; myeloid differentiation factor 88, adult; aged; anemia; Article; asymptomatic disease; blood viscosity; bone marrow; cancer patient; cancer survival; cause of death; cohort analysis; death certificate; disease association; disease course; disease exacerbation; disease specific survival; erythrocyte sedimentation rate; evidence based practice; family history; female; follow up; gene mutation; high risk patient; high risk population; human; intermediate risk population; leukocyte; low risk population; lymphocyte count; lymphocytic infiltration; major clinical study; male; medical record review; patient assessment; patient care; patient monitoring; patient risk; platelet count; polyacrylamide gel electrophoresis; priority journal; proportional hazards model; risk factor; very elderly; Waldenstroem macroglobulinemia; asymptomatic disease; blood; comparative study; decision support system; genetics; immunology; Massachusetts; metabolism; middle aged; mutation; pathology; predictive value; prognosis; risk assessment; time factor; Waldenstroem macroglobulinemia, Adult; Aged; Aged, 80 and over; Asymptomatic Diseases; beta 2-Microglobulin; Biomarkers; Bone Marrow; Boston; Decision Support Techniques; Disease Progression; Female; Humans; Immunoglobulin M; Male; Middle Aged; Mutation; Myeloid Differentiation Factor 88; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Serum Albumin, Human; Time Factors; Waldenstrom Macroglobulinemia
DOI:
10.1200/JCO.19.00394
