Evidence of the modified staging system and comparative performance of IPSS and revised IPSS in a Single-Center Asian cohort with Waldenström macroglobulinemia

Waldenström macroglobulinemia (WM), a rare incurable low-grade B-cell lymphoma, exhibits heterogeneous survival outcomes. We evaluated the prognostic performance of a novel modified staging system of WM (MSS-WM) through comparison with existing models in a single-center cohort of 294 symptomatic WM patients. MSS-WM demonstrated significant stratification capacity (<i>p</i> < 0.0001), with 5-year overall survival rates of 89% (low-risk), 84% (low-intermediate), and 52% (intermediate/high-risk). All MSS-WM factors, including age, serum albumin, and LDH demonstrated independent prognostic impact. In addition, high beta-2 microglobulin level also showed negative prognostic impacts (<i>p</i> = 0.0002). While high concordance of MSS-WM and the revised IPSS (rIPSS-WM) was confirmed, the rIPSS-WM exhibited better predictive accuracy. However, MSS-WM's simplified structure enhances clinical utility, enabling rapid risk stratification: 89% 5-year survival in low-risk vs 52% in high-risk groups. This practical staging system requires no complex calculations, making it preferable for routine clinical implementation while maintaining comparable prognostic discrimination.