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Prognostic Value of the MGUS-Like Phenotype in Multiple Myeloma

By: Julia Fiederlein
Posted: Wednesday, February 16, 2022

Leire Burgos, PhD, of the Clínica Universidad de Navarra, Pamplona, Spain, and colleagues developed an algorithm for the automated identification of patients with multiple myeloma who present with the monoclonal gammopathy of undetermined significance (MGUS)-like phenotype. The findings, which were presented during the 2021 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 541), support the installation of this algorithm in clinical flow cytometry software.

The study included a total of 5,114 patients with monoclonal gammopathies and available flow cytometry data. Based on three routine screening parameters, an algorithm to classify each of these cases by phenotype was developed.

In the training series of smoldering multiple myeloma, patient classification into the MGUS-, intermediate-, or multiple myeloma–like phenotype revealed significantly different 5-year rates of disease progression (0%, 54%, and 66%, respectively); these findings were validated in a cohort of patients with smoldering multiple myeloma (8%, 27%, and 71%, respectively). In the training series of multiple myeloma, patients with the MGUS-like phenotype seemed to experience a significantly longer duration of progression-free (median, 10 vs. 3 years) and overall (median, not reached vs. 6.5 years) survival compared with the remaining patients; in the validation cohort of patients with multiple myeloma, progression-free and overall survival outcomes seemed to significantly differ from those with the MGUS-like phenotype and others with multiple myeloma.

Based on multivariate analyses of progression-free and overall survival, the MGUS-like classification seemed to retain independent prognostic value in the training series of multiple myeloma. The progression-free and overall survival outcomes did not seem to significantly differ among patients with the MGUS-like phenotype regardless of whether they had standard- or high-risk cytogenetics. Patients with MGUS-like transplant-eligible multiple myeloma who underwent induction therapy with proteasome inhibitors, immunomodulatory drugs, and corticosteroids had 5-year progression-free and overall survival rates of 86% and 96%, respectively.

Disclosure: For full disclosures of the study authors, visit

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