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Xu A, Guo T, Zhang S, Luo H, Shen M, Ye Y, Ji L. Prevalence of monoclonal gammopathy of undetermined significance in Shenzhen, China. Hematology 2024; 29:2352686. [PMID: 38819332 DOI: 10.1080/16078454.2024.2352686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Data on the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in China are very limited. Our aim was to determine the prevalence and clinical characteristics of MGUS in a large Chinese population. METHODS This study included 49,220 healthy people who received serum immunofixation electrophoresis (sIFE) and serum protein electrophoresis (SPE) tests. Serum free light chain ratio, immunoglobulin quantification, and other clinically correlates of MGUS were performed for all patients with M-protein. RESULTS A total of 576 MGUS patients were identified by sIFE, with a median age of 58 years and an overall prevalence of 1.17% (95% CI, 1.08-1.27). Among those aged 50 years and older, the prevalence of MGUS was 2.26% (95% CI, 2.04-2.50). The prevalence of MGUS was significantly higher in males than in females (P < 0.05). The median concentration of M-protein was 3.1 g/L, ranging from 0.5 g/L to 25.1 g/L. The M-protein type was IgG in 55.4% of MGUS patients, followed by IgA (31.1%), IgM (9.5%), IgD (0.5%), biclonal (2.3%), and light chain (1.2%). Abnormalities in SPE, FLC ratios, and immunoglobulin levels were observed in 78.3%, 31.1%, and 38.4% of MGUS patients, respectively. CONCLUSIONS The prevalence of MGUS is substantially lower in southern China than in whites and blacks.
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Affiliation(s)
- Anping Xu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Tong Guo
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Shuping Zhang
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Houlong Luo
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Mengxue Shen
- Department of Laboratory Medicine, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yinghui Ye
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
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2
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Saeidi V, Garimella V, Shaji K, Wetter DA, Davis MDP, Todd A, Dutz J, Alavi A. Monoclonal gammopathy in the setting of Pyoderma gangrenosum. Arch Dermatol Res 2024; 316:268. [PMID: 38795175 DOI: 10.1007/s00403-024-03098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 03/28/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by ulcerative painful lesions with violaceous undermined borders. Up to 75% of PG cases develop in association with an underlying systemic disease. Monoclonal gammopathy is reportedly a concomitant condition with PG, with studies indicating immunoglobulin (Ig) A gammopathy as the most common. Whether gammopathy is associated with PG or is an incidental finding has been debated. We sought to investigate the association and characteristics of gammopathy in patients with PG. We retrospectively identified PG patients at our institution from 2010 to 2022 who were screened for plasma cell dyscrasia. Of 106 patients identified, 29 (27%) had a gammopathy; subtypes included IgA (41%), IgG (28%), and biclonal (IgA and IgG) (14%). Mean age was similar between those with and without gammopathy (60.7 vs. 55.9 years; P = .26). In addition, hematologic or solid organ cancer developed in significantly more patients with vs. without gammopathy (8/29 [28%] vs. 5/77 [6%]; P = .003). Among the subtypes of gammopathy, IgG monoclonal gammopathy had the highest proportion of patients with subsequent cancer development (4 of 8 patients, 50%). Study limitations include a retrospective, single-institution design with a limited number of patients. Overall, our data show a high prevalence of gammopathy in patients with PG; those patients additionally had an increased incidence of cancer, especially hematologic cancer.
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Affiliation(s)
- Vahide Saeidi
- Department of Dermatology, Mayo Clinic, Rochester, MN, Canada
| | | | - Kumar Shaji
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, Canada
| | | | - Austin Todd
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Jan Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, Canada.
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3
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Mir M, Aiman W, Baah E, Guron G, Shaaban H. Co-occurrence of High-Risk Myelodysplastic Syndrome With a Complex Karyotype/TP53 Mutation and IgG Lambda Monoclonal Gammopathy of Undetermined Significance. Cureus 2024; 16:e58451. [PMID: 38765410 PMCID: PMC11099498 DOI: 10.7759/cureus.58451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Myelodysplastic syndrome (MDS) represents a group of hematologic disorders marked by abnormal cellular development in the bone marrow, while monoclonal gammopathy of undetermined significance (MGUS) involves abnormal plasma cells without symptomatic manifestations. This paper presents a compelling case of a 74-year-old Hispanic female diagnosed with a rare combination of high-risk MDS characterized by a complex karyotype and TP53 mutation, alongside IgG lambda MGUS. The patient's clinical presentation included a spectrum of symptoms such as body aches, rash, fever, dyspnea, and bloody watery diarrhea. Initial diagnostic evaluations yielded no significant findings, but subsequent investigations revealed abnormalities in both bone marrow and peripheral blood, indicative of coexisting MDS and MGUS. Chromosomal analysis further confirmed the presence of a complex karyotype with multiple aberrations, notably including 5q deletion. This case underscores the rarity of simultaneous high-risk MDS and MGUS, particularly with the additional complexity of a TP53 mutation and complex karyotype. It underscores the imperative for continued research efforts to elucidate the underlying mechanisms and optimal management strategies for such intricate cases. Moreover, it highlights the therapeutic challenges posed by concurrent MDS and plasma cell disorders, advocating for more aggressive interventions such as stem cell transplantation as potential avenues for improved patient outcomes.
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Affiliation(s)
- Marwa Mir
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Wajeeha Aiman
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Esther Baah
- Internal Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Gunwant Guron
- Hematology and Oncology, Saint Michael's Medical Center, Newark, USA
| | - Hamid Shaaban
- Hematology and Oncology, Saint Michael's Medical Center, Newark, USA
- Hematology and Oncology, New York Medical College, Valhalla, USA
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4
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Alejo E, Puertas B, Mateos MV. [Monoclonal gammopathy of uncertain significance]. Med Clin (Barc) 2023; 161:217-224. [PMID: 37330390 DOI: 10.1016/j.medcli.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023]
Abstract
Monoclonal gammopathy of uncertain significance is a premalignant plasma cell neoplasm with a high prevalence in the population over 50 years of age and an annual risk of progression of 1%. Multiple recent studies have led to advances in understanding both the pathogenesis of these disorders and their risk of progression to other diseases. Patients require lifelong follow-up, and a multidisciplinary and risk-adapted approach is essential. In recent years, an increasing number of entities associated with a paraprotein, known as clinically significant monoclonal gammopathies, have been recognized.
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Affiliation(s)
- Elena Alejo
- Hospital Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (IBSAL)/Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, España
| | - Borja Puertas
- Hospital Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (IBSAL)/Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, España
| | - María-Victoria Mateos
- Hospital Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (IBSAL)/Centro Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, España.
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5
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Abstract
Waldenström macroglobulinemia (WM) is a rare subtype of non-Hodgkin lymphoma characterized by the presence of lymphoplasmacytic lymphoma (LPL) in the bone marrow accompanied by a monoclonal immunoglobulin type M (IgM) in the serum. WM was first described only 80 years ago and became reportable in the US as a malignancy in 1988. Very little systematic research was conducted prior to 2000 to characterize incidence, clinical characteristics, risk factors or diagnostic and prognostic criteria, and there were essentially no WM-specific clinical interventional trials. Since the inaugural meeting of the International Workshop in Waldenström's Macroglobulinemia (IWWM) in 2000, WM has become the focus of a steadily increasing and productive body of research, engaging a growing number of investigators throughout the world. This introductory overview provides summary of the current understanding of the epidemiology of WM/LPL as a backdrop for a series of consensus panel recommendations arising from research presented at the 11th IWWM.
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Affiliation(s)
- Mary L McMaster
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health and Human Services, Commissioned Corps of the United States Public Health Service, Washington, DC.
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6
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Kaur J, Valisekka SS, Hameed M, Bandi PS, Varma S, Onwughalu CJ, Ibrahim H, Mongia H. Monoclonal Gammopathy of Undetermined Significance: A Comprehensive Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e195-e212. [PMID: 36966041 DOI: 10.1016/j.clml.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is an asymptomatic premalignant plasma cell dyscrasia with a predominate rise of the IgG immunoglobulin fraction without end-organ damage, often diagnosed incidentally. Despite its progression into various subsequent forms of hematological malignancies, MGUS remains underdiagnosed. A literature search was conducted using the Medline, Cochrane, Embase, and Google Scholar databases, including articles published until December 2022. Keywords used encompassed "Monoclonal Gammopathy of Undetermined Significance," "Plasma Cell dyscrasia," "Monoclonal gammopathy of renal significance," and "IgM Monoclonal gammopathy of Undetermined Significance," This study aimed to conduct a critical review to update knowledge regarding the pathophysiology, risk factors, clinical features, diagnostic protocols, complications, and current and novel treatments for MGUS. We recommend a multidisciplinary approach to manage MGUS due to the complexity of the illness's etiology, diagnosis, and therapy. This comprehensive review also highlights future prospects, such as developing screening protocols for at-risk populations, prevention of disease progression by early diagnosis through genome-wide association studies, and management using Daratumumab and NSAIDs.
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Affiliation(s)
- Jasneet Kaur
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA..
| | | | - Maha Hameed
- Internal Medicine, Florida State University/Sarasota Memorial Hospital, Sarasota, Florida, USA.
| | | | | | | | - Hany Ibrahim
- Ain Shams University, Faculty of Medicine, Cairo, Egypt.
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7
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Thorsteinsdóttir S, Gíslason GK, Aspelund T, Rögnvaldsson S, Óskarsson JÞ, Sigurðardóttir GÁ, Þórðardóttir ÁR, Viðarsson B, Önundarson PT, Agnarsson BA, Sigurðardóttir M, Þorsteinsdóttir I, Ólafsson Í, Eyþórsson E, Jónsson Á, Berlanga O, Hultcrantz M, Durie BGM, Löve TJ, Harding S, Landgren O, Kristinsson SY. Prevalence of smoldering multiple myeloma based on nationwide screening. Nat Med 2023; 29:467-472. [PMID: 36747117 PMCID: PMC11099842 DOI: 10.1038/s41591-022-02183-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/13/2022] [Indexed: 02/08/2023]
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic precursor to multiple myeloma. Here we define the epidemiological characteristics of SMM in the general population in Iceland. The iStopMM study (ClinicalTrials.gov ID: NCT03327597 ) is a nationwide screening study for multiple myeloma precursors where all residents in Iceland 40 years or older were invited to participate. SMM was defined as 10-60% bone marrow plasma cells and/or monoclonal (M) protein concentration ≥3 g dl-1, in the absence of myeloma-defining events. Of the 80,759 who gave informed consent to participate, 75,422 (93%) were screened. The prevalence of SMM in the total population was 0.53% (95% confidence interval (CI) = 0.49-0.57%) in individuals 40 years or older. In men and women, the prevalence of SMM was 0.67% (95% CI = 0.62-0.73%) and 0.39% (95% CI = 0.35-0.43%), respectively; it increased with age in both sexes. For the 193 individuals with SMM, median age was 70 years (range 44-92 years) and 60% were males. The mean M protein concentration of individuals with SMM was 0.62 g dl-1 (range 0.01-3.5 g dl-1) and 73% had 11-20% bone marrow plasma cell infiltration. The high prevalence of SMM has implications for future treatment policies in multiple myeloma as the evidence supporting treatment initiation at the SMM stage is emerging.
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Affiliation(s)
- Sigrún Thorsteinsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Thor Aspelund
- Public Health Sciences, University of Iceland, Reykjavík, Iceland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian G M Durie
- Cedars-Sinai Samual Oschin Cancer Center, Los Angeles, CA, USA
| | | | | | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Landspítali University Hospital, Reykjavík, Iceland.
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8
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Thorsteinsdottir S. The consultant's guide to smoldering multiple myeloma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:551-559. [PMID: 36485144 PMCID: PMC9821526 DOI: 10.1182/hematology.2022000355] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic precursor condition to multiple myeloma (MM). The prevalence of SMM is 0.5% in persons over 40 years old; it is higher in men than women and increases with age. When SMM is diagnosed, a thorough diagnostic workup is necessary to exclude myeloma-defining events and stratify patients according to risk of progression to MM. While close monitoring for progression remains the best management for most patients with SMM, in this article, we discuss if treatment initiation before myeloma-defining events occur might be relevant in selected high-risk cases. Two randomized clinical trials have shown a clinical benefit of initiating treatment at the SMM stage, whereof 1 showed an overall survival benefit for those receiving treatment. We discuss various risk stratification models in SMM, important treatment trials, and ongoing trials. Finally, we present how to approach the clinical management of patients with SMM.
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Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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9
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Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is of considerable clinical importance to primary care physicians given its high prevalence in the general population. MGUS has a variable but lifelong risk for progression to hematologic cancer, such as multiple myeloma, Waldenström macroglobulinemia, or light-chain amyloidosis. In addition, MGUS has been associated with several nonmalignant yet symptomatic disorders that require therapy directed toward eliminating the monoclonal gammopathy. Thus, it is important not only to understand the essentials of diagnosing and monitoring patients with MGUS but also to recognize when to refer patients with MGUS to a specialist.
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Affiliation(s)
- Wilson I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, Minnesota (W.I.G., S.V.R.)
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota (W.I.G., S.V.R.)
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10
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Abeykoon JP, Tawfiq RK, Kumar S, Ansell SM. Monoclonal gammopathy of undetermined significance: evaluation, risk assessment, management, and beyond. Fac Rev 2022; 11:34. [PMID: 36532706 PMCID: PMC9720897 DOI: 10.12703/r/11-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant state for a spectrum of lymphoplasmacytic malignancies. The risk of progression of MGUS to a symptomatic therapy requiring plasma cell dyscrasia is about 1% per year. Studies carried out over the previous 10 years have improved risk stratification of MGUS based on serologic and genomic evaluations, which has led to better management of patients. In this review, we address the epidemiology, diagnosis, and pathogenesis of MGUS and discuss risk-adapted best practice approaches to monitor patients.
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Affiliation(s)
- Jithma P Abeykoon
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Reema K Tawfiq
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Stephen M Ansell
- Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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11
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Steinhardt M, Kortüm M, Einsele H, Rasche L. [Monoclonal gammopathy of (un)known significance]. Dtsch Med Wochenschr 2022; 147:675-682. [PMID: 35636418 DOI: 10.1055/a-1664-7353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Monoclonal gammopathies are a frequently diagnosed entity. However, the diagnosis is not always clinically relevant. The diagnosis of a monoclonal gammopathy requires serum electrophoresis, immunofixation and free light chain measurement. Sometimes, monoclonal gammopathies occur in the course of transient or autoimmune inflammation. Further diagnostics should only be performed after risk assessment according to Mayo criteria. In non-low risk patients, a symptomatic myeloma has to be ruled out via SLiM-CRAB criteria. The diagnostic work-up should include whole-body MRI and a bone marrow puncture as well as a 24 h urine sample. If it does not imply myeloma, the diagnosis of MGUS is confirmed and a follow-up after 6 months is recommended. After that, low-risk patients only need SLiM-CRAB screening at clinical signs of progression. All other patients should receive serologic follow-ups once a year. Importantly, MGUS patients show higher morbidity. Amongst a higher prevalence of osteoporosis and immunodeficiency, a wide array of MGUS-associated diseases such as AL amyloidosis, deposition diseases and Fc binding-dependent effects can occur. This article gives an overview over the work-up, observation and caveats of monoclonal gammopathy of (un)known significance.
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Affiliation(s)
| | - Martin Kortüm
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
| | - Leo Rasche
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg
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12
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Sigurbergsdóttir AÝ, Love TJ, Kristinsson SY. Autoimmunity, Infections, and the Risk of Monoclonal Gammopathy of Undetermined Significance. Front Immunol 2022; 13:876271. [PMID: 35572590 PMCID: PMC9096784 DOI: 10.3389/fimmu.2022.876271] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Various epidemiological studies, including case reports and -series in addition to larger, population-based studies, have reported an increased prevalence of monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma in individuals with a prior history of immune-related conditions. This is believed to support the role of chronic antigen stimulation in the pathogenesis of these conditions. In this short review, we summarize some of the largest population-based studies researching autoimmune diseases, infections, and the subsequent risk of MGUS, and discuss our understanding on its etiology and pathogenesis. Furthermore, we highlight important methodological limitations of previous studies in the field, but almost all studies on MGUS have been based on clinical, possibly biased, cohorts. Finally, we discuss future directions in researching the associations of MGUS and other disorders, including immune-related conditions, where screening studies play an important role.
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Affiliation(s)
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Science and Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Haematology, Landspitali University Hospital, Reykjavik, Iceland
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13
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Kang KW, Song JE, Lee BH, Jeon MJ, Yu ES, Kim DS, Lee SR, Sung HJ, Choi CW, Park Y, Kim BS. A nationwide study of patients with monoclonal gammopathy of undetermined significance with a 10-year follow-up in South Korea. Sci Rep 2021; 11:18449. [PMID: 34531426 PMCID: PMC8445957 DOI: 10.1038/s41598-021-97664-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022] Open
Abstract
In clinical practice, most patients with monoclonal gammopathy of undetermined significance (MGUS) undergo long-term follow-up without disease progression. There is insufficient real-world data about how closely and whether anything other than disease progression should be monitored. Herein, we performed a nationwide study of 470 patients with MGUS with a 10-year follow-up to determine the patterns of disease progression and other comorbidities. During the follow-up period, 158 of 470 patients with MGUS (33.62%) progressed to symptomatic monoclonal gammopathies. Most of these were multiple myeloma (134/470 patients, 28.51%), and those diagnosed within 2 years after diagnosis of MGUS was high. Approximately 30-50% of patients with MGUS had hypertension, diabetes, hyperlipidemia, and osteoarthritis at the time of diagnosis, and these comorbidities were newly developed during the follow-up period in approximately 50% of the remaining patients with MGUS. Approximately 20-40% of patients with MGUS have acute or chronic kidney failure, thyroid disorders, disc disorders, peripheral neuropathy, myocardial infarction, stroke, and heart failure during the follow-up period. Altogether, when MGUS is diagnosed, close follow-up of the possibility of progression to multiple myeloma is required, especially within 2 years after diagnosis; simultaneously, various comorbidities should be considered and monitored during the follow-up of patients with MGUS. Continuous research is needed to establish appropriate follow-up guidelines.
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Affiliation(s)
- Ka-Won Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji Eun Song
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Hyun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Min Ji Jeon
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Eun Sang Yu
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Dae Sik Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Se Ryeon Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Hwa Jung Sung
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Chul Won Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Byung Soo Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
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14
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Fujimura K, Sugiyama A, Akita T, Ohisa M, Nagashima S, Katayama K, Maeda R, Tanaka J. Screening for M-proteinemia consisting of monoclonal gammopathy of undetermined significance and multiple myeloma for 30 years among atomic bomb survivors in Hiroshima. Int J Hematol 2021; 113:576-585. [PMID: 33389658 DOI: 10.1007/s12185-020-03045-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
Monoclonal gammopathy (M-proteinemia) is a premalignant plasma cell disorder. The prevalence of M-proteinemia increases with age and is affected by genetic or environmental factors. Atomic bomb (A-bomb) survivors in Hiroshima are in an age range when they are susceptible to M-proteinemia. The prevalence and incidence of M-proteinemia in Hiroshima A-bomb survivors were investigated for 30 years (1989-2018) to examine the influence of radiation exposure. The overall prevalence of M-proteinemia among 38,602 A-bomb survivors was 2.4%. M-proteinemia prevalence at age 70 years and monoclonal gammopathy of undetermined significance (MGUS) incidence were not associated with radiation exposure category. Males had a 2.30-fold higher prevalence and a 2.08-fold higher incidence than females. The risk of incidence for MGUS was 4.32-fold higher in persons aged < 10 years at the time of the A-bombing and 2.56-fold higher in those aged 10-19 years compared with those aged over 30 years. IgG type M-proteinemia was common and the IgM type developed 5-8 years later than other immunoglobulin types. Exposure to radiation was not clearly associated with the prevalence of M-proteinemia or incidence of MGUS in Hiroshima A-bomb survivors. However, males and those aged < 20 years at A-bombing had higher susceptibility to MGUS.
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Affiliation(s)
- Kingo Fujimura
- Department of Nursing, Yasuda Women's University, 6-13-1 Yasuhigashi Asaminami ward, Hiroshima City, 731-0153, Japan.
- Hiroshima Atomic Bomb Causality Council, Hiroshima City, Japan.
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Masayuki Ohisa
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Shintaro Nagashima
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Keiko Katayama
- Department of Nursing, Yasuda Women's University, 6-13-1 Yasuhigashi Asaminami ward, Hiroshima City, 731-0153, Japan
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
| | - Ryo Maeda
- Hiroshima Atomic Bomb Causality Council, Hiroshima City, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
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15
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Baldursdóttir TR, Löve ÞJ, Gíslason GK, Björkholm M, Mellqvist UH, Lund SH, Blimark CH, Turesson I, Hultcrantz M, Landgren O, Kristinsson SY. Autoimmune disease is associated with a lower risk of progression in monoclonal gammopathy of undetermined significance. Eur J Haematol 2020; 106:380-388. [PMID: 33295006 DOI: 10.1111/ejh.13563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/03/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES AND METHODS We conducted a population-based study including 19 303 individuals diagnosed with MGUS in Sweden from 1985 to 2013, with the aim to determine whether a prior history of autoimmune disease, a well-described risk factor for MGUS is a risk factor for progression of MGUS to multiple myeloma (MM) or lymphoproliferative diseases (LPs). Using the nationwide Swedish Patient registry, we identified MGUS cases with versus without an autoimmune disease present at the time of MGUS diagnosis and estimated their risk of progression. RESULTS A total of 5612 (29.1%) MGUS cases had preceding autoimmune diseases. Using Cox proportional hazards models, we found the risk of progression from MGUS to MM (HR = 0.83, 95% CI 0.73-0.94) and LPs (HR = 0.84, 95% CI 0.75-0.94) to be significantly lower in MGUS cases with prior autoimmune disease (compared to MGUS cases without). CONCLUSIONS In this large population-based study, a history of autoimmune disease was associated with a reduced risk of progression from MGUS to MM/other LPs. Potential underlying reason is that MGUS caused by chronic antigen stimulation is biologically less likely to undergo the genetic events that trigger progression. Our results may have implications in clinical counseling for patients with MGUS and underlying autoimmune disease.
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Affiliation(s)
| | - Þorvarður Jón Löve
- Landspítali, National University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Magnus Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Malin Hultcrantz
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.,Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sigurður Yngvi Kristinsson
- Landspítali, National University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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16
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Jeong S, Kong SG, Kim DJ, Lee S, Lee HS. Incidence, prevalence, mortality, and causes of death in Waldenström macroglobulinemia: a nationwide, population-based cohort study. BMC Cancer 2020; 20:623. [PMID: 32620091 PMCID: PMC7333304 DOI: 10.1186/s12885-020-07120-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The epidemiological features of Waldenström macroglobulinemia (WM) have seldom been investigated at a national level, particularly in East Asia. The goal of our study is to present the incidence, prevalence, mortality, survival with competing risks, and causes of death of patients with WM. METHODS We used a national population-based database, operated by the Health Insurance Review and Assessment Service of the Korean government. This data includes information on all WM patients diagnosed according to uniform criteria, between 2003 and 2016. RESULTS The total number of patients newly diagnosed with WM during the study period was 427, with a male-to-female ratio of 3.2:1. The incidence increased from 0.03 to 0.10 per 105 between 2003 and 2016, and the prevalence was 0.42 per 105 in 2016. A total of 217 patients with WM died during the study period (standardized mortality ratio = 7.57), and the overall survival (OS) of WM patients was 47.5%. On multivariate analysis, older age was associated with worse OS (P < 0.0001). WM was the most common cause of death (n = 102, 48.6%), followed by other malignant neoplasms (n = 82, 39.0%). CONCLUSIONS The national incidence of WM in Korea, a racially homogeneous country in Asia, was lower than that in previous reports from other countries, reflecting ethnic disparities. However, the incidence increased, and mortality was the highest ever reported. The main cause of death was WM in itself. This study reflects the need for greater awareness of WM, particularly in Asian countries.
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Affiliation(s)
- Seri Jeong
- Department of Laboratory Medicine, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441 South Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, 262, Gamcheon-ro, Seo-gu, Busan, 49267 South Korea
| | - Da Jung Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Kosin University College of Medicine, 262, Gamcheon-ro, Seo-gu, Busan, 49267 South Korea
| | - Sangjin Lee
- Department of Statistics, Graduate School, Pusan National University, 2, Busandaehak-ro 63 beon-gil, Geumjeong-gu, Busan, 46241 South Korea
| | - Ho Sup Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Kosin University College of Medicine, 262, Gamcheon-ro, Seo-gu, Busan, 49267 South Korea
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17
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Han JH, Wang JN, Zhang YL, Cao XX, Zhou DB, Xu TD, Su W, Li J. Prevalence of monoclonal gammopathy of undetermined significance in a large population with annual medical check-ups in China. Blood Cancer J 2020; 10:34. [PMID: 32152278 PMCID: PMC7062721 DOI: 10.1038/s41408-020-0303-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jian-Hua Han
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Nuo Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Teng-da Xu
- Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wei Su
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jian Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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18
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Monoclonal gammopathy of undetermined significance. Blood 2019; 133:2484-2494. [PMID: 31010848 DOI: 10.1182/blood.2019846782] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/19/2019] [Indexed: 12/13/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell dyscrasia that consistently precedes multiple myeloma (MM) with a 1% risk of progression per year. Recent advances have improved understanding of the complex genetic and immunologic factors that permit progression from the aberrant plasma cell clone to MGUS and overt MM. Additional evidence supports bidirectional interaction of MGUS cells with surrounding cells in the bone marrow niche that regulates malignant transformation. However, there are no robust prognostic biomarkers. Herein we review the current body of literature on the biology of MGUS and provide a rationale for the improved identification of high-risk MGUS patients who may be appropriate for novel clinical interventions to prevent progression or eradicate premalignant clones prior to the development of overt MM.
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19
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Characteristics and prognosis of patients with non-immunoglobulin-M monoclonal gammopathy of undetermined significance: a retrospective study. Int J Hematol 2018; 109:154-161. [PMID: 30406907 DOI: 10.1007/s12185-018-2555-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/18/2022]
Abstract
Non-immunoglobulin (Ig)-M monoclonal gammopathy of undetermined significance (MGUS) is a precursor lesion with the potential to evolve into a malignant plasma cell neoplasm. The prevalence of MGUS differs by ethnicity and is lower in the Japanese population than in the Western population. However, there is limited evidence about the clinical course of MGUS in Asian races. The present study aims at elucidating the clinical course and prognosis of Japanese patients with non-IgM MGUS in the clinical setting. We retrospectively examined 1009 patients with non-IgM MGUS identified by screening procedures. The median overall survival of these patients was > 20 years, and only one-fifth patients died of plasma cell neoplasms. The cumulative incidence of plasma cell neoplasms requiring treatment was 19%. Multivariate analysis revealed that immunoparesis and female gender were independent factors affecting treatment requirement. Although the characteristics and clinical course of patients with non-IgM MGUS obtained in this study were found to be essentially similar to those of previous studies, we report here for the first time that female gender is a significant independent factor for requiring treatment.
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20
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Ma L, Xu S, Qu J, Hou J, Wang Y, Wen L, Liu Y, Kang Y, Jiang M, Fu W, Du J, Zhou L, Huang X, Zhang Z, Lu J. Monoclonal gammopathy of undetermined significance in Chinese population: A prospective epidemiological study. Hematol Oncol 2018; 37:75-79. [PMID: 30117173 PMCID: PMC6585751 DOI: 10.1002/hon.2548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 01/22/2023]
Abstract
The aim of this study was to identify the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in different groups of age and the clinical features in China. This multicenter prospective study enrolled 1797 health subjects. The overall prevalence of MGUS was 2.73%. The prevalence of different age groups was 1.19% (41‐50 y), 1.16% (51‐60 y), 2.19% (61‐70 y), 3.66% (71‐80 y), and 7.76% (≥81 y). The prevalence of MGUS in male (n = 843) was 2.97%, while the prevalence of MGUS in female (n = 952) was 2.52%, but this difference of the two groups was not statistically significant. As for subtype of MGUS, IgG subtype was 55.1% (27 cases), IgA subtype was 14.3%, and IgM subtype was 12.2%. The M protein of one case became negative after 3 months, and the others remained positive without obvious disease transformation (follow‐up duration: 3‐7 mo). Thus, the prevalence of MGUS in China was similar to that in Mexican Americans, but lower than that in the other Asian country, American Whites, American Blacks, and Africans, and had a trend of increase with age. Male had higher prevalence of MGUS in China. The most common subtype was IgG.
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Affiliation(s)
- Ling Ma
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Shuang Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Jianhua Qu
- Department of Hematology, Xinjiang Medical University First Affiliated Hospital, Xinjiang Uygur Autonomous Region, Urumqi City, 830054
| | - Jian Hou
- Department of Hematology, Second Military Medical University Affiliated Chang Zheng Hospital, Shanghai, China
| | - Yang Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Lei Wen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yang Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ying Kang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ming Jiang
- Department of Hematology, Xinjiang Medical University First Affiliated Hospital, Xinjiang Uygur Autonomous Region, Urumqi City, 830054
| | - Weijun Fu
- Department of Hematology, Second Military Medical University Affiliated Chang Zheng Hospital, Shanghai, China
| | - Juan Du
- Department of Hematology, Second Military Medical University Affiliated Chang Zheng Hospital, Shanghai, China
| | - Lin Zhou
- Department of Hematology, Second Military Medical University Affiliated Chang Zheng Hospital, Shanghai, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Zhaoxia Zhang
- Department of Clinical Laboratory center, Xinjiang Medical University First Affiliated Hospital, Xinjiang Uygur Autonomous Region, Urumqi City, 830054
| | - Jin Lu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
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21
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Gupta R, Dahiya M, Kumar L, Shekhar V, Sharma A, Ramakrishnan L, Sharma OD, Begum A. Prevalence of Monoclonal Gammopathy of Undetermined Significance in India—A Hospital-based Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e345-e350. [DOI: 10.1016/j.clml.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/18/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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22
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Tanaka H, Sakuma Y, Ikeda H, Shimizu R, Sugita Y, Iwai R. Characteristics and Prognosis of Patients with Immunoglobulin M Monoclonal Gammopathy. J Clin Exp Hematop 2018; 57:47-53. [PMID: 29021514 DOI: 10.3960/jslrt.17025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Many patients with immunoglobulin M (IgM) monoclonal gammopathy remain asymptomatic and, consequently, untreated; however, few studies have evaluated the clinical course and prognosis of these patients. Using the screening procedures at our hospital, 74 patients with IgM monoclonal gammopathy were selected. We excluded 11 patients in whom the treatment for lymphoid neoplasms had been initiated at the time of IgM monoclonal protein detection. The remaining 63 patients were considered to be the patient population with IgM MGUS and asymptomatic WM, and were analyzed. In these patients, the median overall survival was longer than 14 years. More than half of these patients died from causes other than lymphoid neoplasm. The cumulative incidence of lymphoid neoplasm requiring treatment was 17.5%. In five of eight patients requiring treatment for lymphoid neoplasms, the causes of death were related with these lymphoid neoplasms. Our study suggests that not all patients with IgM monoclonal gammopathy require uniform treatment for prolonged survival; however, most lymphoid neoplasms requiring treatment are refractory diseases. Our findings may help manage patients with macroglobulinemia.
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Affiliation(s)
| | - Yukie Sakuma
- Clinical Research Support Center, Asahi General Hospital
| | - Hideki Ikeda
- Department of Internal Medicine, Asahi General Hospital
| | - Ryo Shimizu
- Department of Hematology, Asahi General Hospital
| | | | - Rie Iwai
- Department of Transfusion Medicine, Asahi General Hospital
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23
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Laskar DB, Shafique K, Lu C, Zuretti A. Evaluation and characterization of monoclonal gammopathies using serum protein electrophoresis in a major urban population: one institution's experience. J Investig Med 2017; 65:e6. [PMID: 28866632 DOI: 10.1136/jim-2017-000446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Derek B Laskar
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Khurram Shafique
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Chuanyong Lu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Alejandro Zuretti
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York, USA
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24
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25
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Li J, Wen L, Tang J, Zhang H, Zhou Z, Zhang Y, Chen Y, Chen S, Wang Q, Shao J, Wu W, Chen S. Prevalence of Monoclonal Gammopathy of Undetermined Significance in an Apparently Healthy Yixing Population in Mainland China. Acta Haematol 2016; 137:17-19. [PMID: 27825149 DOI: 10.1159/000450881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/19/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Jiao Li
- Hematology Department, Yixing People's Hospital of Jiangsu Province, Yixing, PR China
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26
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Wu SJ, Lin CT, Lin SC, Hsieh PY, Hsu CA, Chu FY, Fazi C, Ghia P, Chuang SS. Similar epidemiological trends of pre-neoplastic precursors and their respective lymphoid malignancies in Taiwan. Ann Hematol 2016; 95:1727-9. [PMID: 27431581 DOI: 10.1007/s00277-016-2747-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Shang-Ju Wu
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Tai-Cheng Stem Cell Transplantation Center, National Taiwan University, Taipei, Taiwan
| | - Shih-Chuang Lin
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Ying Hsieh
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-An Hsu
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fang-Yeh Chu
- Department of Clinical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Claudia Fazi
- Division of Experimental Oncology and Department of Onco-Hematology, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Paolo Ghia
- Division of Experimental Oncology and Department of Onco-Hematology, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy. .,Lab of B cell Neoplasia, Università Vita-Salute San Raffaele di Milano, Via Olgettina 58, Milano, Italy.
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan. .,Department of Pathology, Chi-Mei Hospital, Tainan, Taiwan.
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27
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Cao XX, Meng Q, Mao YY, Su W, Zhen JF, Shen KN, Zhang CL, Huang XF, Duan MH, Zhang W, Zhu TN, Cai HC, Chen M, Zhou DB, Li J. The clinical spectrum of IgM monoclonal gammopathy: A single center retrospective study of 377 patients. Leuk Res 2016; 46:85-8. [DOI: 10.1016/j.leukres.2016.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/12/2016] [Accepted: 05/02/2016] [Indexed: 12/26/2022]
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28
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Go RS, Swanson KM, Sangaralingham LR, Habermann EB, Shah ND. Clinical prevalence (diagnosed cases) of monoclonal gammopathy of undetermined significance in the US: estimating the burden on health care. Leukemia 2015; 30:1443-6. [PMID: 26648533 DOI: 10.1038/leu.2015.336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- R S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - K M Swanson
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - L R Sangaralingham
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - E B Habermann
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - N D Shah
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Optum Labs, Cambridge, MA, USA
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29
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Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma. Hematol Oncol Clin North Am 2014; 28:775-90. [DOI: 10.1016/j.hoc.2014.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Ailawadhi S, Swaika A, Razavi P, Yang D, Chanan-Khan A. Variable risk of second primary malignancy in multiple myeloma patients of different ethnic subgroups. Blood Cancer J 2014; 4:e243. [PMID: 25192415 PMCID: PMC4183772 DOI: 10.1038/bcj.2014.63] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 12/31/2022] Open
Abstract
Second primary malignancies (SPMs) among multiple myeloma (MM) patients have been reported with an estimated incidence varying from 1 to 15%. We have previously reported that significant disparity exists in MM survival across patients of different ethnicities. We undertook a Surveillance Epidemiology and End Results-based analysis to describe the incidence of SPMs among MM patients of different ethnicities, to explore the variable impact that SPMs might have on MM outcomes of patients across racial subgroups. We found that the risk of developing SPMs among MM patients is variable depending on the patient's ethnic background. This warrants further exploration of the impact of SPMs on outcomes of MM patients across different racial subgroups, especially in the form of prospective data collection and analyses.
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Affiliation(s)
- S Ailawadhi
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - A Swaika
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - P Razavi
- Division of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D Yang
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Chanan-Khan
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
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31
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Lee YG, Bang SM, Lee JO, Kim JW, Lee KW, Kim JH, Song JH, Kim TH, Kim KW, Lee JS. Five-Year Follow-up Study of Monoclonal Gammopathy of Undetermined Significance in a Korean Elderly Urban Cohort. Cancer Res Treat 2014; 47:215-20. [PMID: 25345461 PMCID: PMC4398103 DOI: 10.4143/crt.2013.262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/29/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose We previously reported the prevalence of monoclonal gammopathy of undetermined significance (MGUS) to be 3.3% among an elderly Korean urban cohort recruited during 2005-2006. Here, we report a 5-year follow-up study of the previously identified MGUS cohort. Materials and Methods The 680 participants from the initial cohort were followed-up for a median of 5 years. Sera were collected between 2010 and 2011. Two-step screening was performed with standard serum electrophoresis followed by immunofixation and determination of the serum concentration of monoclonal-protein (M-protein). Results Of the 680 participants (21 with MGUS), 348 (51%) agreed to participate in the follow-up study and 10 were found to have MGUS. Among the 21 MGUS patients initially identified, nine were followed-up, six had persistent M-protein, and one patient had progressed to multiple myeloma (progression rate, 1.0%/yr). The M-protein disappeared in the remaining two individuals. Among the 339 participants without MGUS who were followed-up, four developed an M-protein. There was no significant difference in survival with respect to the presence of MGUS (p=0.66). Conclusion The 5-year follow-up data show that the natural clinical course of MGUS in Korea is similar to that in Western countries. MGUS was not associated with an increased risk of death over the 5-year study period.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea ; Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Han Song
- Departments of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Hee Kim
- Departments of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- Departments of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Association between the delta estimated glomerular filtration rate and the prevalence of monoclonal gammopathy of undetermined significance in Korean males. BIOMED RESEARCH INTERNATIONAL 2014; 2014:356080. [PMID: 24895568 PMCID: PMC4034488 DOI: 10.1155/2014/356080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/12/2014] [Accepted: 04/22/2014] [Indexed: 11/22/2022]
Abstract
Background. We investigated the association between the reduction in the estimated glomerular filtration rate (eGFR) and the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in Korean males. Methods. We enrolled 723 healthy Korean males. Serum creatinine concentration, serum electrophoresis, serum immunofixation, and the serum free light chain assay were performed. We calculated delta eGFR per year (ΔeGFR/yr). The prevalence of MGUS was compared based on the ΔeGFR/yr and age group. Results. Thirteen (1.8%) of 723 participants exhibited the monoclonal band on serum immunofixation. Prevalence of MGUS by age group was 0.00% (0/172 for 40 years), 1.63% (6/367 for 60 years), and 3.80% (7/184 for >60 years). The median decrease in ΔeGFR/yr was 5.3%. The prevalence of MGUS in participants in their 50s with >5.3% decline in ΔeGFR/yr was significantly higher than those with <5.3% decrease in ΔeGFR/yr (3.16% versus 0.00%; P = 0.049). The prevalence of MGUS in participants in their 50s with >5.3% decrease in ΔeGFR/yr was similar to that of healthy males in their 60s. Conclusion. Using the rate of reduction in ΔeGFR/yr in healthy Korean males who had their serum creatinine level checked regularly may increase the MGUS detection rate in clinical practice.
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Zwick C, Held G, Auth M, Bernal-Mizrachi L, Roback JD, Sunay S, Iida S, Kuroda Y, Sakai A, Ziepert M, Ueda R, Pfreundschuh M, Preuss KD. Over one-third of African-American MGUS and multiple myeloma patients are carriers of hyperphosphorylated paratarg-7, an autosomal dominantly inherited risk factor for MGUS/MM. Int J Cancer 2014; 135:934-8. [PMID: 24443359 DOI: 10.1002/ijc.28731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/19/2013] [Indexed: 11/05/2022]
Abstract
As hyperphosphorylated paratarg-7 (pP-7) carrier state was shown to be the first molecularly defined autosomal dominantly inherited risk factor for monoclonal gammopathy of unknown significance (MGUS) and multiple myeloma (MM) in a European population, the prevalence of pP-7 carrier state among African-Americans who have a significantly higher incidence of MGUS/MM is of interest. We therefore determined pP-7 carrier state and paraproteins with specificity for P-7 in African-American, European and Japanese patients with MGUS/MM and healthy controls. By isoelectric focusing and ELISA, a paratarg-7-specific paraprotein and the associated pP-7 carrier state was observed in 30/81 (37.0%) African-American, 42/252 (16.7%) European and 7/176 (4.0%) Japanese MGUS/MM patients (p < 0.001). A pP-7 carrier state was found in 11/100 (11.0%) African-American, 8/550 (1.5%) European and 1/278 (0.4%) Japanese healthy controls (p < 0.001), resulting in an odds ratio for MGUS/MM of 4.8 (p < 0.001) among African-American, 13.6 among European (p < 0.001) and 11.5 (p = 0.023) among Japanese carriers of pP-7. We conclude that pP-7 carriers are most prevalent among African-Americans, but a pP-7 carrier state is the strongest molecularly defined single risk factor for MGUS/MM known to date in all three ethnic groups. The high prevalence of pP-7 carriers among African-American patients emphasizes a predominant role of this genetic factor in the pathogenesis of these diseases. The large number of pP7 African-American patients and controls should facilitate the identification of the SNP or mutation underlying the pP-7 carrier state.
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Affiliation(s)
- Carsten Zwick
- Department of Internal Medicine I, José-Carreras-Center for Immuno and Gene Therapy, Homburg/Saar, Germany
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Iwanaga M, Tomonaga M. Prevalence of Monoclonal Gammopathy of Undetermined Significance in Asia: A Viewpoint From Nagasaki Atomic Bomb Survivors. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:18-20. [DOI: 10.1016/j.clml.2013.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/12/2013] [Indexed: 11/16/2022]
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Malhotra J, Kremyanskaya M, Schorr E, Hoffman R, Mascarenhas J. Coexistence of Myeloproliferative Neoplasm and Plasma-Cell Dyscrasia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:31-6. [DOI: 10.1016/j.clml.2013.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
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Iwanaga M, Chiang CJ, Soda M, Lai MS, Yang YW, Miyazaki Y, Matsuo K, Matsuda T, Sobue T. Incidence of lymphoplasmacytic lymphoma/Waldenström's macroglobulinaemia in Japan and Taiwan population-based cancer registries, 1996-2003. Int J Cancer 2013; 134:174-80. [PMID: 23784625 DOI: 10.1002/ijc.28343] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/23/2013] [Accepted: 05/31/2013] [Indexed: 02/01/2023]
Abstract
Few studies have investigated the incidence rate of lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia (LPL/WM) in Asian populations. We assessed the incidence of LPL/WM using data from 13 population-based cancer registries in Japan and data from the Taiwan National Cancer registry. During 1996-2003, a total of 280 new cases of LPL/WM were recorded in Japan and 56 were recorded in Taiwan, with the median age at diagnosis being 73 and 67 years, respectively. The incidence of LPL/WM showed male predominance in both countries. Crude age-specific incidence rates increased sharply with age in both countries, especially in people >65 years. Age-standardized (to the World standard population) incidence rates per 100,000 person-years were 0.043 (0.071 for men and 0.023 for women) and 0.031 (0.041 for men and 0.020 for women) in Japan and Taiwan, respectively. Age-standardized (to the 2,000 US standard population) incidence rates in Japan and Taiwan were lower than rates reported in the literature for Asians living in the United State. A significant increasing trend was observed in the incidence over the period from 1996 to 2003 in Japan alone. This report suggests that both environmental and/or genetic factors may be involved in LPL/WM development.
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Affiliation(s)
- Masako Iwanaga
- Graduate School of Public Health, Teikyo University, Tokyo, Japan; Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Goldin LR, McMaster ML, Caporaso NE. Precursors to lymphoproliferative malignancies. Cancer Epidemiol Biomarkers Prev 2013; 22:533-9. [PMID: 23549397 PMCID: PMC3616401 DOI: 10.1158/1055-9965.epi-12-1348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We review monoclonal B-cell lymphocytosis (MBL) as a precursor to chronic lymphocytic leukemia and monoclonal gammopathy of undetermined significance (MGUS) as a precursor to plasma cell disorders. These conditions are present in the general population and increase with age. These precursors aggregate with lymphoproliferative malignancies in families suggesting shared inheritance. MBL and MGUS may share some of the same risk factors as their related malignancies but data are limited. Although these conditions are characterized by enhanced risk for the associated malignancy, the majority of individuals with these conditions do not progress to malignancy. A key focus for current work is to identify markers that predict progression to malignancy.
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Affiliation(s)
- Lynn R Goldin
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, 6120 Executive Blvd., Bethesda, MD 20892, USA.
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39
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Cherry BM, Costello R, Zingone A, Burris J, Korde N, Manasanch E, Kwok M, Annunziata C, Roschewski MJ, Engels EA, Landgren O. Immunoparesis and monoclonal gammopathy of undetermined significance are disassociated in advanced age. Am J Hematol 2013; 88:89-92. [PMID: 23169485 DOI: 10.1002/ajh.23355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 09/28/2012] [Accepted: 10/13/2012] [Indexed: 01/09/2023]
Abstract
Immunoparesis and a skewed serum free light chain (FLC) ratio are indicators of immune dysfunction predictive of progression from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). Previous studies have reported increased prevalence of MGUS by age, but no study has examined the relationship between immunoparesis and abnormal FLC ratios in the elderly. We screened 453 older adults (median age, 80 years; range, 65-96) to characterize the patterns of immunoparesis and abnormal FLC ratio in relation to MGUS. We defined MGUS in 4.4% of the subjects; the prevalence was 12.5% among individuals of >90 years. In MGUS (vs. non-MGUS) cases, immunoparesis and abnormal FLC ratios were detected in 70.0% (vs. 49.0%; P = 0.07) and 50.0% (vs. 12.9%; P = 0.0001), respectively. Based on small numbers, MGUS patients with abnormal FLC ratio were borderline (P = 0.07) more likely to have immunoparesis. Overall, the prevalence of immunoparesis varied in a nonlinear fashion, with lowest frequencies in the youngest and oldest groups. Our observed disassociation between MGUS prevalence and impaired immunoglobulin production suggests that separate mechanisms are involved in the development of MGUS and immunoparesis in advanced age. These findings emphasize the need for molecularly defined methods to characterize myeloma precursor states and better predict progression to MM.
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Affiliation(s)
- Benjamin M. Cherry
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Rene Costello
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Adriana Zingone
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Jason Burris
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Neha Korde
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Elisabet Manasanch
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Mary Kwok
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Christina Annunziata
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Mark J. Roschewski
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; National Institutes of Health; Rockville; Maryland
| | - Ola Landgren
- Multiple Myeloma Section; National Cancer Institute; National Institutes of Health; Bethesda; Maryland
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Nakamura H, Endo M, Sugawara E, Kuwahara M, Kusunoki S, Tanaka F, Takahashi T. [A case of IgM paraproteinemic neuropathy associated with anti-sulfated glucuronic paragloboside (SGPG) IgG antibody without anti-myelin-associated glycoprotein (MAG) activity]. Rinsho Shinkeigaku 2013; 53:799-802. [PMID: 24225562 DOI: 10.5692/clinicalneurol.53.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a case of IgM paraproteinemic neuropathy associated with anti-sulfated glucuronic paragloboside (SGPG) IgG antibody. An 84-year old man complained of numbness on the left side of the face and in the distal portions of the limbs. Neurological examination showed mild sensory ataxia. The laboratory tests revealed the presence of IgM lambda paraproteinemia and anti-SGPG IgG antibody without anti-myelin-associated glycoprotein (MAG) activity and anti-MAG/SGPG IgM antibody. Results of nerve conduction study showed decreased sensory nerve action potential (SNAP) amplitude, indicating the presence of sensory-dominant axonal polyneuropathy, and the prolongation of distal latency was not observed. Treatment with corticosteroids resulted in a rapid improvement in neurological abnormalities. In IgM paraproteinemic neuropathy associated with anti-MAG/SGPG antibody, distal acquired demyelinating sensory neuropathy and resistance to immunological treatments are the characteristic pathologic and clinical features, respectively. On the other hand our rare case of IgM paraproteinemic neuropathy positive for anti-SGPG IgG antibody presented with axonal sensory polyneuropathy and a good responsiveness to corticosteroids.
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Affiliation(s)
- Haruko Nakamura
- Department of Neurology, National Hospital Organization Yokohama Medical Center
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Agarwal A, Ghobrial IM. Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma: a review of the current understanding of epidemiology, biology, risk stratification, and management of myeloma precursor disease. Clin Cancer Res 2012; 19:985-94. [PMID: 23224402 DOI: 10.1158/1078-0432.ccr-12-2922] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The term monoclonal gammopathy of undetermined significance (MGUS) was coined in 1978. The recent advances in our knowledge about MGUS and smoldering multiple myeloma (SMM) have helped us better understand the pathogenesis of myeloma. It seems that myeloma evolves from a precursor state in almost all cases. We do not completely understand the multistep process from the precursor state to myeloma, but studies like whole genome sequencing continue to improve our understanding of this process. The process of transformation may not be linear acquisition of changes, but rather a branched heterogeneous process. Clinical features that are prognostic of rapid transformation have been identified, but no specific molecular markers have been identified. Even with recent advances, multiple myeloma remains an incurable disease in the vast majority, and intervening at the precursor state provides a unique opportunity to alter the natural history of the disease. A limitation is that a vast majority of patients with precursor disease, especially low-risk MGUS, will never progress to myeloma in their lifetime, and treating these patients is not only unnecessary but may be potentially harmful. The challenge is to identify a subset of patients with the precursor state that would definitely progress to myeloma and in whom interventions will have a meaningful impact. As our understanding of the molecular and genetic processes improves, these studies will guide the selection of high-risk patients more appropriately and ultimately direct a tailored management strategy to either delay progression to symptomatic myeloma or even "cure" a person at this premalignant stage.
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Affiliation(s)
- Amit Agarwal
- Division of Hematology/Oncology, University of Arizona, Tuscon, Arizona 02215, USA
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Bianchi G, Ghobrial IM. Does my patient with a serum monoclonal spike have multiple myeloma? Hematol Oncol Clin North Am 2012; 26:383-93, ix. [PMID: 22463833 DOI: 10.1016/j.hoc.2012.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A monoclonal spike on serum protein electrophoresis is a frequent finding in the general population and pathognomonic of a plasma cell dyscrasia. In otherwise healthy individuals, it is diagnostic of two asymptomatic, premalignant conditions called monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) which carry a lifelong risk of progression to multiple myeloma (MM) or related malignancy. This article discusses the criteria for diagnosis of MGUS, SMM, and MM; current recommendations for follow-up and risk factors for progression to MM of patients with MGUS and SMM; and diagnostic evaluation of suspected MM transformation.
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Affiliation(s)
- Giada Bianchi
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Onwah AL, Adeyemo TA, Adediran A, Ajibola SO, Akanmu AS. Prevalence and type of monoclonal gammopathy of undetermined significance in an apparently healthy Nigerian population: a cross sectional study. BMC BLOOD DISORDERS 2012; 12:7. [PMID: 22742514 PMCID: PMC3502492 DOI: 10.1186/1471-2326-12-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022]
Abstract
Background The prevalence of monoclonal gammopathy of undetermined significance (MGUS), a premalignant plasma-cell disorder has not been determined in our geographic area Nigeria. Methods A cross sectional survey was carried on apparently healthy Nigerians selected by multistage sampling technique from the cosmopolitan city of Lagos, Nigeria. Subjects enrolled into the study had 2-step screening for the presence, type and concentration of monoclonal band. Agarose-gel electrophoresis was performed on all serum samples, and any serum sample with a discrete band of monoclonal protein or thought to have a localized band was subjected to Immunofixation. Subjects were also evaluated for Bence jones proteinuria, haematological and biochemical parameters. Results Four hundred and ten subjects with a mean age of 45.68 ± 10.3 years, a median of 45.00 years and a range of 20 to 80 years were enrolled into the study. MGUS was identified in only one (0.24 percent) of the 410 study subject. This subject was demonstrated to have a double monoclonal gammopathy; IgGλ at 16.9 g/L and IgAκ at 8.5 g/L. None of them including the sole subject with MGUS had a monoclonal urinary light chain. Conclusion Among residents of Lagos, Nigeria, MGUS was found in only 0.24% percent of apparently normal persons with a median age of 45 years. This suggests that MGUS which represents the earliest stage of monoclonal plasma/lymphoid cell proliferation is not a common finding in the relatively young population of Nigeria. Future epidemiologic studies dealing with plasma cell disorders in older people are required to carefully examine the relationship between environmental factors and prevalence of MGUS and its ultimate progression to MM.
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Affiliation(s)
- A Lawretta Onwah
- Department of Haematology & Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, P,M,B, 12003, Marina, Lagos, Nigeria.
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Familial monoclonal gammopathy of undetermined significance and multiple myeloma: epidemiology, risk factors, and biological characteristics. Blood 2012; 119:5359-66. [PMID: 22354002 DOI: 10.1182/blood-2011-11-387324] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS), a precursor to multiple myeloma (MM), is one of the most common premalignant conditions in the general population. The cause of MGUS is largely unknown. Recent studies show that there is an increased prevalence of MGUS in blood relatives of persons with lymphoproliferative and plasma cell proliferative disorders, suggesting presence of shared underlying genetic influences. In the past few years, additional studies have examined risk factors and biologic characteristics that may contribute to the increased prevalence of MGUS among relatives of probands with MGUS, MM, and other blood malignancies. This article reviews the known epidemiology and risk factors for familial MGUS and myeloma, the risk of lymphoproliferative disorders and other malignancies among blood-relatives of patients with MGUS and MM, and discusses future directions for research.
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Greenberg AJ, Vachon CM, Rajkumar SV. Disparities in the prevalence, pathogenesis and progression of monoclonal gammopathy of undetermined significance and multiple myeloma between blacks and whites. Leukemia 2011; 26:609-14. [PMID: 22193966 DOI: 10.1038/leu.2011.368] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is marked racial disparity in the incidence of monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma, with a two to threefold increased risk in blacks compared with whites. The increased risk has been seen both in Africans and African Americans. Similarly, an increased risk of monoclonal gammopathies in blacks compared with whites has been noted after adjusting for socioeconomic and other risk factors, suggesting a genetic predisposition. The higher risk of multiple myeloma in blacks is likely a result of the higher prevalence of the premalignant MGUS stage; there are no data to suggest that blacks have a higher progression rate of MGUS to myeloma. Studies are emerging that suggest the baseline cytogenetic characteristics, and progression may differ by race. In contrast, to the increased risk noted in blacks, studies suggest that the risk may be lower in certain racial and ethnic groups, notably persons from Japan and Mexico. We review the literature on racial disparity in the prevalence, pathogenesis and progression of MGUS and multiple myeloma between blacks and whites. We also discuss future directions for research that could inform management of these conditions and positively influence patient outcomes.
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Affiliation(s)
- A J Greenberg
- Division of Epidemiology, Department of Health Sciences Research, Rochester, MN, USA
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Incidence, clinical course, and prognosis of secondary monoclonal gammopathy of undetermined significance in patients with multiple myeloma. Blood 2011; 118:2985-7. [PMID: 21765020 DOI: 10.1182/blood-2011-04-349175] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
During the course of multiple myeloma (MM), new monoclonal proteins of an isotype distinct from the original clone, referred to as secondary monoclonal gammopathy of undetermined significance (MGUS), have been described. We report on the frequency, characteristics, and outcome of secondary MGUS. Of the 1942 patients with MM, 128 (6.6%) developed a secondary MGUS, at a median of 12 months from the diagnosis of MM. The median duration of secondary MGUS was 5.9 months. Secondary MGUS was more common in patients after stem cell transplantation than in those who had not undergone such treatment (22.7% vs 1.6%, P < .001). Overall survival was significantly superior in MM patients who developed secondary MGUS compared with the rest of the cohort (73 vs 38 months, respectively; P < .001). The time of onset and the duration of secondary MGUS, as well as failure to resolve spontaneously, had an effect on overall survival and require further study.
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Landgren O, Kyle RA, Rajkumar SV. From myeloma precursor disease to multiple myeloma: new diagnostic concepts and opportunities for early intervention. Clin Cancer Res 2011; 17:1243-52. [PMID: 21411440 PMCID: PMC5901666 DOI: 10.1158/1078-0432.ccr-10-1822] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Since monoclonal gammopathy of undetermined significance (MGUS) was first described more than 30 years ago, the definition of the entity has evolved. Today, 3 distinct clinical MGUS subtypes have been defined: non-immunoglobulin M (IgM; IgG or IgA) MGUS, IgM MGUS, and light chain MGUS. Each clinical MGUS subtype is characterized by unique intermediate stages and progression events. Although we now have strong evidence that multiple myeloma is consistently preceded by a precursor state at the molecular level, there is urgent need to better understand mechanisms that regulate transformation from precursor to full-blown multiple myeloma. In the future, if such knowledge was available, it would allow clinicians to define high-risk and low-risk precursor patients for a more tailored clinical management. Also, it would provide insights on the individual patient's disease biology, which, in turn, can be used for targeted and more individualized treatment strategies. On the basis of current clinical guidelines, patients diagnosed with MGUS and smoldering myeloma should not be treated outside of clinical trials. In the near future, it seems reasonable to believe that high-risk precursor patients will likely become candidates for early treatment strategies. In this review, we discuss novel insights from recent studies and propose future directions of relevance for clinical management and research studies.
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Affiliation(s)
- Ola Landgren
- Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA.
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48
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McMaster ML, Landgren O. Prevalence, clinical aspects, and natural history of IgM MGUS. CYTOMETRY PART B-CLINICAL CYTOMETRY 2010; 78 Suppl 1:S91-7. [PMID: 20839342 DOI: 10.1002/cyto.b.20550] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Waldenström macroglobulinemia (WM) and chronic lymphocytic leukemia (CLL) are related B-cell cancers that share several clinical and biological features. Both WM and CLL have associated precursor conditions: monoclonal gammopathy of undetermined significance (MGUS) of immunoglobulin M (IgM) type and monoclonal B-cell lymphocytosis (MBL), respectively. Recently, a case of MBL with an IgM MGUS was reported, suggesting a close biological relationship between these entities. While much is known about MGUS overall, investigations of IgM MGUS specifically have been fragmentary. METHODS In this article, we review data on the prevalence, clinical aspects and natural history of IgM MGUS, and focus on identifying gaps in our understanding of the complex relationships among B-cell malignancies and their precursors. RESULTS There appears to be marked heterogeneity in the prevalence of IgM MGUS across populations. However, studies have varied in definition, design, laboratory methods, and endpoints. IgM MGUS differs from non-IgM MGUS in certain respects, including prevalence across racial groups, rate of progression, and pattern of malignant outcomes. There are limited data regarding the coincident occurrence of IgM MGUS and MBL. CONCLUSIONS Future studies incorporating both protein electrophoresis and flow cytometry are needed to define the underlying spectrum and causes of precursor development, risk factors for progression, and markers that distinguish low- and high-risk precursor patients.
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Affiliation(s)
- Mary L McMaster
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-7236, USA.
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Mailankody S, Mena E, Yuan CM, Balakumaran A, Kuehl WM, Landgren O. Molecular and biologic markers of progression in monoclonal gammopathy of undetermined significance to multiple myeloma. Leuk Lymphoma 2010; 51:2159-70. [PMID: 20958231 DOI: 10.3109/10428194.2010.525725] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multiple myeloma (MM) is a malignant plasma cell dyscrasia localized in the bone marrow. Recent studies have shown that MM is preceded in virtually all cases by a premalignant state called monoclonal gammopathy of undetermined significance (MGUS). This review focuses on non-IgM MGUS and its progression to MM. Although certain clinical markers of MGUS progression have been identified, it currently is not possible to accurately determine individual risk of progression. This review focuses on the various biologic and molecular markers that could be used to determine the risk of MM progression. A better understanding of the pathogenesis will allow us to define the biological high-risk precursor disease and, ultimately, to develop early intervention strategies designed to delay and prevent full-blown MM.
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Affiliation(s)
- Sham Mailankody
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder that is associated with a lifelong risk of multiple myeloma. We conducted a systematic review of all studies investigating the prevalence and incidence of MGUS in the online database PubMed. The review was conducted from January 6, 2009, through January 15, 2010. The following MeSH search headings were used: monoclonal gammopathy, benign and prevalence; monoclonal gammopathy, benign and incidence; paraproteinemia and prevalence; and paraproteinemia and incidence. Articles were limited to those written in English and published by January 2009. Fourteen studies that met prespecified criteria were included and systematically assessed to identify the most accurate prevalence estimates of MGUS based on age, sex, and race. On the basis of our systematic review, we estimate that the crude prevalence of MGUS in those older than 50 years is 3.2% in a predominantly white population. Studies in white and Japanese populations demonstrate a clear increase in prevalence with age. The prevalence is also affected by sex: 3.7% and 2.9% in white men and women, respectively; and 2.8% and 1.6% in Japanese men and women, respectively. Additionally, MGUS is significantly more prevalent in black people (5.9%-8.4%) than in white people (3.0%-3.6%). We conclude that MGUS is a common premalignant plasma cell disorder in the general population of those older than 50 years. The prevalence increases with age and is affected by race, sex, family history, immunosuppression, and pesticide exposure. These results are important for counseling, clinical care, and the design of clinical studies in high-risk populations.
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Affiliation(s)
| | - S. Vincent Rajkumar
- Individual reprints of this article are not available. Address correspondence to S. Vincent Rajkumar, MD, Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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