Serum Immune Marker and Progression From MGUS to Multiple Myeloma
Posted: Thursday, October 3, 2019
Patients with low- or intermediate-risk monoclonal gammopathy of undetermined significance (MGUS) may experience disease conversion to high-risk MGUS and progression to multiple myeloma within a 5-year window. Ola Landgren, MD, PhD, of the Memorial Sloan Kettering Cancer Center (MSK) in New York, published work with a team of researchers in JAMA Oncology, supporting annual blood testing for all individuals diagnosed with MGUS.
“Previously reported annual risk of progression from MGUS to multiple myeloma of 0.5% to 1% reflected the average risk among all MGUS cases but were not applicable to individual patients. In the current study, we found that the risk of progression is not constant,” said Dr. Landgren in an MSK press release.
The team utilized a prospective cross-sectional cohort study using the National Cancer Institute Prostate, Lung, Colorectal, and Ovarian screening trial, where 77,469 cancer-free patients were followed from November 1993 to December 2011. Patients who had a diagnosis of progressing or stable MGUS and also had available serially stored prediagnostic samples were identified.
A total of 685 individuals met inclusion criteria. Via cross-sectional modeling, several risk factors were found to be associated with progressive MGUS: IgA isotype (odds ratio = 1.80), 15 g/L or more monoclonal spike (odds ratio = 23.5), skewed serum free light chain ratio (odds ratio = 46.4), and severe immunoparesis (odds ratio = 19.1). Risk factors for progressive light chain MGUS included skewed serum free light chain ratio (odds ratio = 44.0) and severe immunoparesis (odds ratio = 48.6). Approximately 53% (23/43) participants had high-risk MGUS before disease progression, and 16 of the 23 patients (70%) experienced conversion from low- or intermediate-risk MGUS within 5 years. This same pattern was observed for patients with light chain MGUS, suggesting the need for annual risk assessment for all individuals with MGUS.
Disclosure: The study authors’ disclosure information may be found at jamanetwork.com.
