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.
The IPSSWM is especially useful for physicians who report large-scale data on the outcomes of patients in clinical trials. It is less useful in characterizing the prognosis of an individual WM patient whose prognosis may also depend on overall health, access to therapy, tolerance to treatment and side effects, and other factors.
Much of the older literature on WM quotes a median survival rate of 5-7 years after diagnosis, and this number still unfortunately 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, proteasome inhibitors, and B-cell pathway inhibitors, were widely used.
As treatments continue to improve and responses to treatment last longer, recent studies are suggesting median survival rates closer to 14-16 years after diagnosis. Since WM patients tend to be older and diagnosed in their 60s and above, this puts survival rates closer to those expected for the “normal” population.
Prognosis and survival are discussed by Dr. Jeffrey Matous of the Colorado Blood Cancer Institute in a short video entitled "Doctor, How Long Am I Going to Live?"