Bustoros M, et al. - In order to better understand the risk of progression from asymptomatic Waldenström macroglobulinemia (AWM) to overt Waldenström macroglobulinemia (WM), researchers assessed 439 patients with AWM who were diagnosed and observed between 1992 and 2014. Over the study period, including a median follow-up of 7.8 years, 317 patients progressed to symptomatic WM (72%). Independent predictive factors for disease progression included immunoglobulin M 4,500 mg/dL or greater, bone marrow lymphoplasmacytic infiltration 70% or greater, β2-microglobulin 4.0 mg/dL or greater, and albumin 3.5 g/dL or less. Researchers trained and cross-validated a proportional hazards model with bone marrow infiltration, immunoglobulin M, albumin, and beta-2 microglobulin values as continuous measures to measure progression risk in with AWM patients. They were able to define three distinct risk groups via this model: a high-risk group with a median time to progression (TTP) of 1.8 years, an intermediate-risk group with a median TTP of 4.8 years, and a low-risk group with a median TTP of 9.3 years. For possibly the first time, patients with high-risk AWM who may need closer follow-up or benefit from early intervention could be identified.