MARKERS ASSOCIATED WITH SHORT SURVIVAL IN PATIENTS WITH WALDENSTRÖM MACROGLOBULINEMIA
Author(s): ,
Gordon Ruan
Affiliations:
Internal Medicine,Mayo Clinic,Rochester,United States
,
Jithma Abeykoon
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Saurabh Zanwar
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Morie Gertz
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Stephen Ansell
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Craig Reeder
Affiliations:
Hematology,Mayo Clinic,Arizona,United States
,
Sikander Ailawadhi
Affiliations:
Hematology,Mayo Clinic,Jacksonville,United States
,
Angela Dispenzieri
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
David Dingli
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Martha Lacy
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Ronald Go
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Nelson Leung
Affiliations:
Nephrology,Mayo Clinic,Rochester,United States
,
Francis Buadi
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Wilson Gonsalves
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Robert Kyle
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Vincent Rajkumar
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
,
Shaji Kumar
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
Prashant Kapoor
Affiliations:
Hematology,Mayo Clinic,Rochester,United States
EHA Library. Ruan G. Jun 14, 2019; 266284; PF484
Dr. Gordon Ruan
Dr. Gordon Ruan
Contributions
Abstract

Abstract: PF484

Type: Poster Presentation

Presentation during EHA24: On Friday, June 14, 2019 from 17:30 - 19:00

Location: Poster area

Background

Waldenström Macroglobulinemia (WM) is a rare, indolent B-cell lymphoplasmacytic malignancy. Patient outcomes are highly heterogeneous, with a proportion of patients surviving less than 5 years (short survivors) and another proportion that survive longer than 10 years. The laboratory parameters in the currently used International Prognostic Scoring System for WM (IPSSWM) include hemoglobin, serum IgM, platelet count, and serum β2-microglobulin.

Aims
We aim to identify unique patient characteristics and prognostic features associated with short survival in WM.

Methods

The medical records of patients with active WM that were diagnosed at Mayo Clinic Rochester, Arizona, and Florida between January 1st, 1996 and December 31st, 2013 were reviewed. The patients with smoldering WM were excluded. Cohorts of patients who either survived ≤ 5 years (Short Survival Group) or those with an overall survival (OS) ≥ 10 years (Long Survival Group) from the diagnosis of active disease were compared. Survivors with a follow-up of ≤ 5 years were not included in the analyses. Two-sided Wilcoxon rank sum test and Chi square/Fisher’s exact test were used to compare the continuous and categorical variables, respectively. The variables that were statistically significant on univariate analysis (P<0.05) were included in a multivariate logisitic regression analysis.

Results

Of 893 consecutively seen WM patients (median follow-up of 9 years [95% CI 8.4-9.7]), we identified 387 patients who could be categorized into either the Short Survival Group (n=171 patients, 44%) or the Long Survival Group (n=216, 56%). The Short Survival Group had a median OS of 2.4 years (2.1-2.8) and median age at diagnosis of 73 years (42-93), while the Long Survival Group (n=216, 56%) had a median OS of 18.9 years (16-NR) and median age at diagnosis of 62 years (31-85). The baseline characteristics and significant findings between the two groups are listed in the Table. Parameters significant on univariate analysis included age > 65 years, albumin < 3.5 g/dL, β2-microglobulin > 3 µg/ml, and LDH > upper limit of normal (ULN). On multivariate analysis, albumin < 3.5 g/dL and LDH > ULN were independently associated with short survival. Among the Long Survivors, 60 (28%) patients survived 15 years or more.

Table. Comparison of clinical features between Short and Long Survivor Groups.

Parameters

Short Survivors

n (%)

Long Survivors

n (%)

p-value (univariate)

p-value (multivariate)

*Age > 65 y

123 (72)

85 (39)

<0.0001

0.39

MYD88L265P

20 (77)

36 (72)

0.8

 

*Hemoglobin ≤ 11.5 g/dL

92 (73)

94 (68)

0.4

 

*Platelets ≤ 100 x 109/L

15 (15)

15 (14)

0.8

 

Marrow lymphocytosis > 50%   

53 (42)

47 (35)

0.25

 

*IgM > 7000 mg/dL

24 (19)

22 (15)

0.5

 

Albumin < 3.5 g/dL

59 (62)

38 (40)

0.003

0.004

*β2-microglobulin > 3 µg/ml

51 (77)

29 (46)

0.0003

0.79

Serum LDH > ULN

16 (26)

5 (7)

0.007

<0.0001

*Cut-offs used in the ISSWM Staging Criteria

Conclusion
Lactate dehydrogenase above the ULN and serum albumin <3.5 g/dL are independent biomarkers of short survival in WM. The MYD88L265P status and the size of serum IgM are not prognostic in WM. Our data suggest the need for simplification of the current staging system with the use of widely available markers: serum albumin and lactate dehydrogenase.

Session topic: 18. Indolent and mantle-cell non-Hodgkin lymphoma - Clinical

Keyword(s): Clinical data, Clinical outcome, Waldenstrom's macroglobulinemia

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