Progression patterns in monoclonal gammopathy of undetermined significance and multiple myeloma outcome: a cohort study in 42 patients

Experimental Hematology & Oncology

Johan Hultdin¹  Wendy Yi-Ying Wu²  Florentin Späth³  Widad Tahiru³  Antonio Izarra Santamaria³ 

[1] Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden;Department of Radiation Sciences, Oncology, Umeå University, 90187, Umeå, Sweden;Department of Radiation Sciences, Oncology, Umeå University, 90187, Umeå, Sweden;Department of Radiation Sciences, Oncology and Cancer Center, Hematology, Umeå University, 90187, Umeå, Sweden;

关键词: Multiple myeloma;    Myeloma outcome;    Aggressive myeloma;    MGUS;    Low-risk MGUS;    MGUS follow-up;    MGUS progression;    Prospective blood samples;    NSHDS;   

DOI  :  10.1186/s40164-022-00259-0

来源: Springer

【 摘 要 】

Follow-up of low-risk monoclonal gammopathy of undetermined significance (MGUS) is debated as multiple myeloma (MM) progression risk is low. Worse MM outcome was reported for patients followed for low-risk MGUS, possibly due to less optimal follow-up. However, it is unknown whether progressing low-risk MGUS is associated with aggressive tumor behavior. Understanding these patterns is crucial for MGUS management. Here, we investigated whether progression from low-risk MGUS is associated with worse MM outcome in patients who had no MGUS follow-up before myeloma diagnosis. We retrospectively determined the MGUS status in repeated pre-diagnostic blood samples prospectively collected from 42 myeloma patients in median 11.6 years (first sample) and 3.3 years (repeated sample) before myeloma diagnosis. At first pre-diagnostic blood draw, 12 had low-risk (defined by an immunoglobulin [Ig] G monoclonal [M] spike < 15 g/L and a normal free light-chain ratio) and 30 had MGUS of other risk. MM bone disease was more common in patients with low-risk MGUS at first blood draw (67% vs. 30%, P = 0.041). Median survival since myeloma diagnosis was worse in low-risk than other MGUS at first blood draw (2.3 vs. 7.5 years, P = 0.004). Modest progression was observed between first and repeated blood draw for the majority of low-risk MGUS as 67% remained as low- or low-intermediate-risk MGUS at repeated blood draw. Our study, albeit limited by its small size, indicates that progression from low-risk MGUS is associated with worse MM outcome regardless of MGUS follow-up. Although further investigation is needed, progressing low-risk MGUS could belong to a group of aggressive tumors with progression that is difficult to predict.

【 授权许可】

CC BY