Journal of Clinical Oncology, Vol 11, 1553-1558, Copyright © 1993 by American Society of Clinical Oncology
Prognostic factors in Waldenstrom's macroglobulinemia: a report of 167 cases
T Facon, M Brouillard, A Duhamel, P Morel, M Simon, JP Jouet, F Bauters and P Fenaux
Service des Maladies du Sang, Lille, France.
PURPOSE: A single-center retrospective analysis was conducted in 167
patients with Waldenstrom's macroglobulinemia (WM) to delineate prognostic
factors. PATIENTS AND METHODS: One hundred sixty-seven patients diagnosed
between January 1969 and December 1988, fulfilling diagnostic criteria of
WM, were entered onto this study. One hundred twenty-eight patients were
treated with chlorambucil (0.1 mg/kg/d): 117 at diagnosis and 11 during the
disease course. Seventeen variables were analyzed in all patients and in
treated patients for their prognostic value on survival using the
Kaplan-Meier method and a Cox multivariate regression analysis. RESULTS:
Median survival duration for all patients was 60 months. Pretreatment
factors associated with shorter survival in the entire population were age
> or = 60 years (P = .006), male sex (P = .0001), general symptoms (P =
.01), hemoglobin less than 10 g/dL (P = .008), leukocytes less than 4 X
10(9)/L (P = .02), neutrophils less than 1.7 X 10(9)/L (P = .02), and
platelets less than 150 X 10(9)/L (P = .0006). Organomegaly, signs of
hyperviscosity, renal failure, monoclonal immunoglobulin M (M IgM) level,
blood lymphocytosis, and percentage of marrow lymphoid cells were not
significantly correlated with survival. In a Cox multivariate regression
analysis, the combination of factors that gave the best prognostic value
was the association of sex (P = .0002), neutrophils (P = .002), age (P =
.008), and hemoglobin (P = .02). CONCLUSION: Our findings suggest that some
pretreatment parameters, including older age, male sex, general symptoms,
and cytopenias, carry a poor prognosis in WM. By contrast, high initial
tumor burden (indicated by organomegaly, high IgM level, and high
percentage of marrow lymphoid cells) does not seem to be significantly
associated with short survival. Our results help define a high-risk
population that could perhaps benefit from newer therapeutic approaches.
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