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Study of prognosis in Waldenstrom's macroglobulinemia: a proposal for a
simple binary classification with clinical and investigational utility
PG Gobbi, R Bettini, C Montecucco, L Cavanna, S Morandi, C Pieresca, G Merlini, D Bertoloni, G Grignani and U Pozzetti
Clinica Medica II, Universita di Pavia, IRCCS S. Matteo, Italy.
Prognostic evaluation of Waldenstrom's macroglobulinemia (WM) is
unreliable, few studies considered prognostic factors in WM and only one
was derived from a multivariate analysis. One hundred forty-four
retrospective, previously untreated patients with clinically overt WM were
studied to learn whether overall survival was related to any of the various
clinical features presented at diagnosis. Patients were homogeneously
treated with intermittent doses of chlorambucil for as long as this showed
an effect on the monoclonal component. The population was randomly
subdivided into a 90-patient exploratory sample, on whom investigation
would be conducted, and in a 54-patient test sample, on whom the results
would be validated. In the exploratory sample univariate analysis
identified the following parameters as the most important for prognosis:
age (< or > or = 70 years), platelet count (< or > or = 120 x
10(9)/L), presence or absence of an abnormal number of red blood cells in
the urine, hemoglobin concentration (< or > or = 9 g/dL), erythrocyte
sedimentation rate (< or > or = 110 mm at first hour), presence or
absence of cryoglobulinemia and of weight loss. Cox multivariate analysis
showed that only hemoglobin, age, weight loss, and cryoglobulinemia
independently affected survival. These four clinical variables were also
shown to be able to discriminate survival significantly in the test sample.
Moreover, it was possible to demonstrate (both in the exploratory and the
test sample) that clear-cut, albeit dichotomic, survival discrimination can
be reached with the presence at diagnosis of either no more than one, or
any two or more, of these four prognosticators. These simple clinical
criteria could be the basis of an initial binary, prognostic classification
of WM, which could help in differentiating therapy according to the
severity of the disease, and in properly designing future clinical trials.
Volume 83,
Issue 10,
pp. 2939-2945,
05/15/1994
Copyright © 1994 by The American Society of Hematology
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