Fw: Italian Study on MGUS

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From: " sey (by way of ilena rose) " <fuchsmorrissey@...>

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Sent: Monday, March 18, 2002 9:58 AM

Subject: Italian Study on MGUS

This may be of interest to those who have MGUS. You may wish to post. TAke

care, Fuchs-sey

Journal of Clinical Oncology, Vol 20, Issue 6 (March), 2002: 1625-1634

Prognostic Factors for Malignant Transformation in Monoclonal

Gammopathy of Undetermined Significance and Smoldering Multiple

Myeloma

By Clara Cesana, Klersy, Luciana Barbarano,

Nosari, Crugnola, Ester Pungolino, Livio Gargantini, Simonetta

Granata, Marina Valentini, Enrica Morra

From the Department of Hematology, Bone Marrow Transplantation Centre,

and Laboratory of Clinical Biochemistry and Hematology, Niguarda Cý

Granda Hospital, Milan; Department of Biometry and Clinical

Epidemiology, Scientific Direction, Istituto di Ricovero e Cura a

Carattere Scientifico San Matteo General Hospital, Pavia; and

Department of Hematology, University of Parma, Parma, Italy.

PURPOSE: To evaluate the natural history of monoclonal gammopathy of

undetermined significance (MGUS) and smoldering multiple myeloma (SMM),

identify early predictors of evolution, and assess whether associated

conditions correlate with disease progression.

PATIENTS AND METHODS: A total of 1,231 consecutive patients with either

MGUS (n = 1,104) or SMM (n = 127) diagnosed from July 1975 to March 1998

were included in the study. Cumulative survival probability and cumulative

probability of transformation into lymphoproliferative disease were

calculated by means of the Kaplan-Meier estimator. Univariate and

multivariate models were used to identify possible predictors of

malignant evolution.

RESULTS: Cumulative transformation probability at 10 and 15 years was 14%

and 30%, respectively. At a median follow-up of 65 months (range, 12 to 239

months), 64 MGUS cases (5.8%) evolved to multiple myeloma (MM) (n = 43),

extramedullary plasmacytoma (n = 1), primary amyloidosis (n = 1),

Waldenstr-mís macroglobulinemia (n = 12), non-Hodgkinís lymphoma (n = 6),

and B-chronic lymphocytic leukemia (n = 1). At a median follow-up of 72

months (range, 12 to 247 months), 25 SMMs (19.7%) evolved to overt MM. A

lower evolution risk was observed in MGUS than in SMM (P < .0001). Greater

than 5% marrow plasmacytosis, detectable Bence proteinuria,

polyclonal serum immunoglobulin reduction, and high erythrocyte

sedimentation rate (ESR) were independent factors influencing MGUS

transformation. SMM progression correlated with greater than 10% marrow

plasma cells, detectable Bence proteinuria, and immunoglobulin (Ig) A

isotype. Neither concomitant diseases nor immunosuppression correlated with

progression.

CONCLUSION: Careful evaluation of marrow plasmacytosis, urinary

paraprotein, background immunoglobulins, ESR, and paraprotein isotype might

help identify at presentation patients with benign monoclonal gammopathies

requiring stricter monitoring.