Presenting features of monoclonal gammopathies: an analysis of 684 newly diagnosed cases

Ucci, G.; Riccardi, Alberto; Luoni, R; Ascari, E

doi:10.1111/j.1365-2796.1993.tb00726.x

Cited by 19 publications

(10 citation statements)

References 19 publications

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“…An elevated ESR was found more frequently in individuals with multiple myeloma compared to benign monoclonal gammopathy (average ESR for monoclonal gammopathy of undetermined significance is 28.2 mm/hr and 82.4 mm/hr for multiple myeloma). 10 An elevated ESR is also associated with Hodgkin's disease and an elevated ESR after chemotherapy for Hodgkin's disease has been found to be a poor predictor of survival. 11 Patients with collagen vascular diseases, significant infection, or malignancy almost always have symptoms or signs that suggest a more involved or complicated disorder than what is expected in an individual with usual atopy.…”

Section: Esr In Allergy/immunologymentioning

confidence: 99%

Uses of Erythrocyte Sedimentation Rate in Allergy/Immunology

Reichmuth¹,

Ledford²

2002

Pediatric Asthma, Allergy & Immunology

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The erythrocyte sedimentation rate (ESR), one of the original tests of modern medicine, is a relatively simple procedure that continues to be used in evaluating medical conditions. Its function in the allergist/clinical immunologist's practice is to assess patients with an unusual presentation of a normally encountered condition for an underlying disorder, e.g., a severe asthmatic with Churg Strauss syndrome. It is also used to identify potential etiologies of some disorders, such as vasculitis causing chronic urticaria. It is neither completely sensitive nor specific for diagnosing any disorder; thus, it is adjunctive to the history, physical exam, and other laboratory and radiological studies. The ESR does not have a role in assessing uncomplicated atopic conditions. (Pediatr Asthma Allergy Immunol 2002; 15[3]: 167-171.) METHODOLOGY T HE NATIONAL COMMITTEE FOR CLINICAL LABORATORY STANDARDS recommends the Westergren methodas the standard to determine the ESR. 1 This technique has not significantly changed over the last 70 years. 2 Four milliliters of whole blood is mixed with 1.0 mL of sodium citrate. This mixture is added to a Westergren tube, a vertical 2.5-mm diameter tube that is 30-cm long with the top 20 cm calibrated from 0 to 200 mm. The tube is filled to the zero mark at room temperature. At 60 minutes the upper level of the settled red blood cells (RBCs) is measured in millimeters from the zero mark. This value, in millimeters per hour, is the erythrocyte sedimentation rate (ESR). The modified Westergren method uses the same technique, but ethylenediaminetetraacetic acid (EDTA) is used as an anticoagulant to permit assaying other hematologic tests with the same sample. A micro-ESR method useful in newborns utilizes a similar technique but only requires 0.2 mL of blood. 1 The normal Westergren ESR is 0-2 mm/hr in a newborn, 0-10 mm/hr in a child, 0-15 mm/hr in a female adult, and 0-10 mm/hr in a male adult. 3 The ESR normally increases with age. For men, normal results are less than 30-40 mm/hr for ages older than 85 years and 30 mm/hr or less for ages 50-85 years. Similarly, for normal women, results are 42 mm/hr or less for ages older than 85 years and 30 mm/hr or less for ages 50-85 years. 1,4 A rule of thumb for the normal ESR in men is age in years divided by 2, and in women, age in years, divided by 2 plus 5-10.

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Section: Esr In Allergy/immunologymentioning

confidence: 99%

Uses of Erythrocyte Sedimentation Rate in Allergy/Immunology

Reichmuth¹,

Ledford²

2002

Pediatric Asthma, Allergy & Immunology

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“…Dès la mise en évidence de leur potentiel évolutif malin les études de cohorte ont tenté d'identifier des facteurs prédictifs Ucci [8] Pfitzenmeyer [17] Aucun facteur prédictif identifié Pasqualetti [32] Decaux [18] Blade [6] Isotype IgA 3).…”

Section: Critères Prédictifs De Transformation Maligneunclassified

“…Avec la modernisation des techniques biologiques et le vieillissement de la population, la fréquence des GMSI devrait croître régulièrement, ce qui ne manquera pas de poser des problèmes médico-économiques. Le potentiel évolutif des GMSI a été parfaitement identifié par Kyle dès 1978 [5] et ultérieurement confirmé par de nombreuses études [6][7][8][9][10][11][12][13][14][15][16][17][18]. De ce fait, les GMSI sont considérées comme de véritables états prénéoplasiques [19].…”

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Transformation maligne des gammapathies monoclonales de signification indéterminée

Decaux

Avet-Loiseau²,

Grosbois

2007

La Presse Médicale

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“…Differential diagnosis should be made among multiple myeloma (MM), other lymphoproliferative diseases or monoclonal gammopathy of undetermined significance (MGUS). The most common differential diagnosis problem is deciding between MM and MGUS (1)(2)(3). The clinical spectrum of MM is broad and 20-30% of patients with MM are indistinguishable from MGUS (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…The most common differential diagnosis problem is deciding between MM and MGUS (1)(2)(3). The clinical spectrum of MM is broad and 20-30% of patients with MM are indistinguishable from MGUS (1)(2)(3)(4). MGUS is characterised by the presence of a serum monoclonal protein (M-protein) -35 g/L for IgG or -20 g/L for IgA, fewer than 10% plasma cells in the bone marrow, none or only a small amount of Bence Jones protein and the absence of symptoms (bone lesions, anaemia, hypercalcaemia or renal insufficiency) associated with lymphoproliferative disease (5).…”

Section: Introductionmentioning

confidence: 99%

The predictive power of serum κ/λ ratios for discrimination between monoclonal gammopathy of undetermined significance and multiple myeloma

Bergón¹,

Miravalles²,

Bergón³

et al. 2005

Clinical Chemistry and Laboratory Medicine (CCLM)

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The predictive power of serum kappa/lambda ratios on initial presentation of immunoglobulin G (IgG) or IgA monoclonal component was studied to differentiate between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) patients. The retrospective study involved 145 patients clinically diagnosed with monoclonal gammopathy of undetermined significance or multiple myeloma, who had serum M-protein IgG <35 g/L or IgA <20 g/L at M-protein detection. Serum light chains kappa and lambda were measured by fixed-time nephelometry. Test performance indices, predictive values and likelihood ratios were calculated according to the Weissler recommendation. MM patients were considered as diseased and MGUS patients as non-diseased in order to estimate the performance characteristics of serum kappa/lambda ratios. There was a statistically significant difference in kappa/lambda ratios distribution between both groups of patients, in both M-protein kappa-type (Mann-Whitney U=168, p<0.001) and in M-protein lambda-type (Mann-Whitney U=143, p<0.001). Negative likelihood ratios at threshold levels of 0.6 and 4.2 were 2.17- and 3.32-fold greater, respectively, than positive likelihood ratios, so that the predictive power of a serum kappa/lambda ratio within these limits is better in ruling out (negative predictive power) than ruling in disease (positive predictive power). The post-test characteristics of a serum kappa/lambda ratio interval between 0.6 and 4.2 in discriminating MGUS from MM in our geographic population were: sensitivity 0.96 (0.93-0.99 95% CI); specificity 0.70 (0.63-0.77); positive predictive value 0.68 (0.64-0.73); negative predictive value 0.96 (0.94-0.99); likelihood ratios (+)LR 3.23 (2.68-4.04); and (-)LR 17.16 (11.00-63.00). Thus, serum M-protein with a kappa/lambda ratio between 0.6 and 4.2 increases the posterior probability of MGUS from 0.60 to 0.96 in asymptomatic patients, for whom only monitoring may be suggested when the serum kappa/lambda ratio is within these limits.

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Presenting features of monoclonal gammopathies: an analysis of 684 newly diagnosed cases

Abstract: The study suggests that 20% BMPC can be taken as a safe cut-off point at which to differentiate MGUS from early MM and outlines a few simple parameters which can be of diagnostic aid.

Cited by 19 publications

References 19 publications

Uses of Erythrocyte Sedimentation Rate in Allergy/Immunology

Uses of Erythrocyte Sedimentation Rate in Allergy/Immunology

Transformation maligne des gammapathies monoclonales de signification indéterminée

The predictive power of serum κ/λ ratios for discrimination between monoclonal gammopathy of undetermined significance and multiple myeloma

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