The word prognosis comes from the Greek prognostikos (of knowledge beforehand) - combining pro (before) and gnosis (a knowing).
Prognosis is therefore defined as the prospect of recovery or the prediction of the future course of a condition or disease. These forecasts are based on medical knowledge and clinical research of other patients with the same or similar symptoms. Prognosis often includes chances of improvement or degeneration and long-term outcomes.
A recent method for predicting patient survival has been developed from the results of prognostic studies. The International Prognostic Scoring System for Waldenström’s Macroglobulinemia (IPSSWM) was developed by Dr. Pierre Morel of France and is now internationally accepted as a predictive model to characterize long-term outcome for newly diagnosed patients. According to the model, factors predicting 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.
- Elevated serum lactate dehydrogenase (LDH) - a typical normal range is 104-333 IU/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.
Additionally, Dr. Irene Ghobrial of the Dana Farber Cancer Institute has reviewed the records of 337 patients with newly diagnosed symptomatic WM betwen 1960 and 2001 seen at the Mayo Clinic, Rochester, MN. The disease-specific survival was found to be 11.6 years, and, of those who died, only 53% passed away due to WM or complications of therapy.
It should be noted that Dr. Ghobrial's analysis was done for patients diagnosed quite some time ago, and has led her and other top WM researchers from around the world to be convinced that the survival is much better today given the rapid improvements in therapeutic options for WM patients. Dr. Ghobrial has, in fact, 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 FINAL WORD..
Given that the median disease-specific survival in symptomatic WM patients is longer than has been previously described, it is imperative that therapeutic interventions be selected carefully to prevent treatment-related complications and that optimal treatment in WM patients avoid toxicity and preserve future quality of life.