Prognosis is a prediction of the probable course of a condition or disease.
The International Prognostic Scoring System for Waldenström Macroglobulinemia (IPSSWM) was developed by Dr. Pierre Morel of France and presented at the Fourth International Workshop on Waldenström’s Macroglobulinemia in 2007. It is now internationally accepted as a predictive model to characterize long-term outcome for symptomatic patients requiring therapy. According to the model, factors negatively impacting survival are:
- Age: more than 65 years;
- Hemoglobin: less than 11.5 g/dL;
- Platelet count: less than 100×109/L;
- B2-microglobulin: greater than 3 mg/L;
- Serum monoclonal protein concentration: greater than 70 g/L.
The risk categories are:
Low: If less than 1 adverse variable, except age;
Intermediate: 2 adverse characteristics, or age over 65 years;
High: More than 2 adverse characteristics.
In 2009 the Southwest Oncology Group identified increased serum lactate dehydrogenase (LDH) as another adverse variable affecting prognosis. A typical normal range for LDH is 104-333 IU/L.
Much of the older literature on WM quotes a survival rate of 5-7 years after diagnosis, and this number still shows up from time to time. Patients should be aware that this was based on studies conducted before many of the newer treatments, especially monoclonal antibodies and proteasome inhibitors, were widely used.
Dr. Irene Ghobrial of the Dana-Farber Cancer Institute reviewed the records of 337 patients with newly diagnosed symptomatic WM between 1960 and 2001 seen at the Mayo Clinic, Rochester, MN. The median survival from time of diagnosis was 6.4 years; however, this included deaths from all causes. Only 53% died from WM or from complications of therapy. The disease-specific survival was 11.2 years.
Since Dr. Ghobrial's analysis was performed on patients diagnosed quite some time ago, she and other noted WM researchers are convinced that survival is much better today given the rapid improvements in therapeutic options for WM patients. Dr. Ghobrial has stated that "the overall survival does not accurately represent WM since many patients are older and they die from another cause like heart disease, other cancers, etc."
A similar opinion about survival is discussed by Dr. Jeffrey Matous of the Colorado Blood Cancer Institute in a short video entitled "Doctor, How Long Am I Going to Live?"