The Role of Diagnosis and Clinical Follow-up of Monoclonal Gammopathy of Undetermined Significance on Survival in Multiple Myeloma

Sigurdardottir, Elin Edda; Turesson, Ingemar; Lund, Sigrún H.; Lindqvist, Ebba K.; Mailankody, Sham; Korde, Neha; Björkholm, Magnus; Landgren, Ola; Kristinsson, Sigurður Y.

doi:10.1001/jamaoncol.2015.23

Cited by 117 publications

(121 citation statements)

References 23 publications

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“…At the moment of diagnosis, the following baseline prognostic factors were recorded: age, sex, Eastern Cooperative Oncology Group performance status score, the occurrence of weight loss, body mass index, number of comorbidities, diagnostic delay, treatment delay, presence of previously documented precursor disease [27], International Staging System (ISS), light chain MM [28], percentage of bone marrow plasma cells by morphology, serum creatinine (mg/dL), estimated glomerular filtration rate (mL/min/1.73 m 2 ), free light chain ratio (involved/uninvolved), lactate dehydrogenase (U/L), high-risk [t (4;14), t(14;16), 11q, and del(17p)] cytogenetic abnormalities by fluorescent in situ hybridization, and extramedullary disease by positron emission tomography with 18 fluorine-fluoro-deoxyglucose integrated with computed tomography.…”

Section: Methodsmentioning

confidence: 99%

Early mortality in multiple myeloma: the time‐dependent impact of comorbidity: A population‐based study in 621 real‐life patients

et al. 2016

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Multiple myeloma is a heterogeneous disease with variable survival; this variability cannot be fully explained by the current systems of risk stratification. Early mortality remains a serious obstacle to further improve the trend toward increased survival demonstrated in recent years. However, the definition of early mortality is not standardized yet. Importantly, no study has focused on the impact of comorbidity on early mortality in multiple myeloma to date. Therefore, we analyzed the role of baseline comorbidity in a large populationbased cohort of 621 real-life myeloma patients over a 31-year period. To evaluate early mortality, a sequential multivariate regression model at 2, 6, and 12 months from diagnosis was performed. It was demonstrated that comorbidity had an independent impact on early mortality, which is differential and time-dependent. Besides renal failure, respiratory disease at 2 months, liver disease at 6 months, and hepatitis virus C infection at 12 months, were, respectively, associated with early mortality, adjusting for other well-established prognostic factors. On the other hand, the long-term monitoring in our study points out a modest downward trend in early mortality over time. This is the first single institution population-based study aiming to assess the impact of comorbidity on early mortality in multiple myeloma. It is suggested that early mortality should be analyzed at three key time points (2, 6, and 12 months), in order to allow comparisons between studies. Comorbidity plays a critical role in the outcome of myeloma patients in terms of early mortality.Am. J. Hematol. 91:700-704,

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Section: Methodsmentioning

confidence: 99%

Early mortality in multiple myeloma: the time‐dependent impact of comorbidity: A population‐based study in 621 real‐life patients

et al. 2016

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“…The challenges of diagnosing multiple myeloma include the need for clinicopathological symptoms; summarized by the acronym CRAB: increased serum Calcium concentration, Renal insufficiency, Anemia, and lytic Bone lesions. In multiple myeloma, early detection is associated with 15% better overall survival [19] and less severe complications [20]. In order to intervene in high-risk SMM prior to end organ damage, the International Myeloma Working Group (IMWG) has recently updated the definition of multiple myeloma by adding three biomarker-characterized myeloma defining events to the CRAB acronym: 1) presence of bone marrow plasma cells > 60% as a differentiation from smoldering multiple myeloma; 2) serum of involved FLC ratio is > 100; 3) magnetic resonance imaging (MRI) with more than one skeletal focal lesion ( Table 2).…”

Section: Monoclonal Gammopathies Overview and Categorizationmentioning

confidence: 99%

Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell dyscrasias

Willrich

Katzmann

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:Monoclonal immunoglobulins are markers of plasma cell proliferative diseases and have been described as the first (and perhaps best) serological tumor marker. The unique structure of each monoclonal protein makes them highly specific for each plasma cell clone. The difficulties of using monoclonal proteins for diagnosing and monitoring multiple myeloma, however, stem from the diverse disease presentations and broad range of serum protein concentrations and molecular weights. Because of these challenges, no single test can confidently diagnose or monitor all patients. Panels of tests have been recommended for sensitivity and efficiency. In this review we discuss the various disease presentations and the use of various tests such as protein electrophoresis and immunofixation electrophoresis as well as immunoglobulin quantitation, free light chain quantitation, and heavy-light chain quantitation by immuno-nephelometry. The choice of tests for inclusion in diagnostic and monitoring panels may need to be tailored to each patient, and examples are provided. The panel currently recommended for diagnostic screening is serum protein electrophoresis, immunofixation electrophoresis, and free light chain quantitation.

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“…This may avoid hospitalizations and costs and also preserve quality of life. Indeed, two recent population studies have shown benefits of MGUS follow-up [68,69]. First, a Swedish study showed improved survival of MM patients with prior knowledge of MGUS, suggesting that earlier treatment of MM leads to better survival [69].…”

Section: Fo Ll Ow-u P Follow-up Of Mgus Patientsmentioning

confidence: 99%

“…Indeed, two recent population studies have shown benefits of MGUS follow-up [68,69]. First, a Swedish study showed improved survival of MM patients with prior knowledge of MGUS, suggesting that earlier treatment of MM leads to better survival [69]. Secondly, the SEER database analysis showed that MGUS follow-up was an independent predictor of lower rates of complications at the diagnosis of malignancy [68].…”

Section: Fo Ll Ow-u P Follow-up Of Mgus Patientsmentioning

confidence: 99%

Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma

Donk

Mutis

Poddighe

et al. 2016

Int J Lab Hematology

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KeywordsMonoclonal gammopathy of undetermined significance, smoldering multiple myeloma, multiple myeloma, diagnosis, management, treatment S U M M A RYMonoclonal gammopathy of undetermined significance (MGUS) is one of the most common premalignant disorders. IgG and IgA MGUS are precursor conditions of multiple myeloma (MM), whereas light-chain MGUS is a precursor condition of light-chain MM. Smoldering MM (SMM) is a precursor condition with higher tumor burden and higher risk of progression to symptomatic MM compared to MGUS. Assessment of the risk of progression of patients with asymptomatic monoclonal gammopathies is based on various factors including clonal burden, as well as biological characteristics, such as cytogenetic abnormalities and light-chain production. Several models have been constructed that are useful in daily practice for predicting risk of progression of MGUS or SMM. Importantly, the plasma cell clone may occasionally be responsible for severe organ damage through the production of a M-protein which deposits in tissues or has autoantibody activity. These disorders are rare and often require therapy directed at eradication of the underlying clone. Importantly, recent studies have shown that asymptomatic patients with a bone marrow plasma cell percentage ≥60%, free light-chain ratio ≥100, or >1 focal lesion on MRI (myeloma-defining events) have a 80% risk of developing symptomatic MM within 2 years. These patients are now considered to have MM requiring therapy, similar to patients with symptomatic disease. In this review, we provide an overview of the new diagnostic criteria of the monoclonal gammopathies and discuss risk of progression to active MM. We also provide recommendations for the management of patients with MGUS and SMM including risk-adapted follow-up.

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The Role of Diagnosis and Clinical Follow-up of Monoclonal Gammopathy of Undetermined Significance on Survival in Multiple Myeloma

Cited by 117 publications

References 23 publications

Early mortality in multiple myeloma: the time‐dependent impact of comorbidity: A population‐based study in 621 real‐life patients

Early mortality in multiple myeloma: the time‐dependent impact of comorbidity: A population‐based study in 621 real‐life patients

Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell dyscrasias

Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma

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