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Cancer Epidemiol Biomarkers Prev. 2019 Sep 9. pii: cebp.0132.2019. doi: 10.1158/1055-9965.EPI-19-0132. [Epub ahead of print]

Post-MGUS diagnosis serum monoclonal-protein velocity and the progression of monoclonal gammopathy of undetermined significance to multiple myeloma.

Author information

1
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis changsh@wudosis.wustl.edu.
2
Research Service, St. Louis Veterans Affairs Medical Center.
3
Hematology, Washington University in St. Louis School of Medicine.
4
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine.

Abstract

BACKGROUND:

Multiple myeloma (MM) is a common hematologic malignancy consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Little is known about post-diagnosis clinical predictors of progression of MGUS to MM to guide MGUS management. This study aimed to investigate whether the rate of rise in serum monoclonal protein concentration during the year after MGUS diagnosis (M-protein velocity) predicts progression of MGUS to MM.

METHODS:

Data from the U.S. Veterans Health Administration system were used. A retrospective cohort of MGUS patients who progressed to MM were matched on age at MGUS diagnosis and race in a 1:4 ratio to the MGUS patients using incidence density sampling. Kaplan-Meier curves were plotted. Univariable and multivariable conditional logistic regression analyses were fitted from the matched risk sets.

RESULTS:

A total of 128 cases and 490 matched controls were included. The case group contained a higher percentage of patients with M-protein velocity >0.1 g/dL/year than the control group (44.5% versus 28.2%, p<0.0001). M-protein velocity of >0.1 g/dL during the year following MGUS diagnosis was positively associated with progression of MGUS to MM (multivariable-adjusted odds ratio=2.15; 95% confidence interval=1.37 to 3.35).

CONCLUSION:

Patients with a positive M-protein velocity during the year after MGUS diagnosis may be considered for more frequent monitoring for early detection and timely treatment of MM. Future prevention studies could target these patients for intervention evaluation.

IMPACT:

Our results suggest a new clinical predictor of progression to MM following MGUS diagnosis, which has potential to identify high-risk patients for management and prevention.

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