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Monoclonal Gammopathy of Undetermined Significance: Predictors of Malignant Transformation and Recognition of an Evolving Type Characterized by a Progressive Increase in M Protein Size

  • Laura Rosiñol
    Affiliations
    Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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  • M. Teresa Cibeira
    Affiliations
    Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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  • Silvia Montoto
    Affiliations
    Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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  • María Rozman
    Affiliations
    Hematopathology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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  • Jordi Esteve
    Affiliations
    Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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  • Xavier Filella
    Affiliations
    Biochemistry Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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  • Joan Bladé
    Correspondence
    Individual reprints of this article are not available. Address correspondence to Joan Bladé, MD, Hematology Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
    Affiliations
    Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
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      OBJECTIVE

      To investigate the predictors of monoclonal gammopathy of undetermined significance (MGUS) by considering not only the initial features but also the pattern of evolution of the M protein during the first years after diagnosis.

      PATIENTS AND METHODS

      This study consisted of 359 patients diagnosed as having MGUS at a single institution. Patients who showed a definite and progressive increase in their M protein size according to serum electrophoresis during the first 3 years of follow-up were considered to have evolving MGUS, whereas all others were considered to have nonevolving MGUS.

      RESULTS

      Of the 359 patients, 330 had nonevolving MGUS, whereas 29 fulfilled the criteria for evolving MGUS. Overall, 32 patients developed malignant transformation. The progression rates at 10 and 20 years of follow-up for the evolving and the nonevolving types were 55% vs 10% and 80% vs 13%, respectively. Multivariate analysis revealed that the features significantly associated with a higher risk of progression were evolving MGUS (relative risk [RR], 12.14; P<.001), IgA MGUS (RR, 2.93; P=.006), and M protein concentration (RR, 2.18; P=.04).

      CONCLUSION

      The evolutionary pattern of serum M protein (progressive increasing vs stable) during the first years of follow-up is the most important risk factor for disease progression in patients with MGUS.
      BMPC (bone marrow plasma cell), MGUS (monoclonal gammopathy of undetermined significance), RR (relative risk), SMM (smoldering multiple myeloma)
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