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Medline ® Abstract for Reference 31

of 'Clinical course and management of monoclonal gammopathy of undetermined significance'

31
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Changing pattern of presentation in monoclonal gammopathy of undetermined significance: a single-center experience with 1400 patients.
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Varettoni M, Corso A, Cocito F, Mangiacavalli S, Pascutto C, Zappasodi P, Pica G, Lazzarino M
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Medicine (Baltimore). 2010;89(4):211.
 
To assess whether the pattern of presentation and the outcome of monoclonal gammopathy of undetermined significance (MGUS) have changed over the last 3 decades, we evaluated 1400 patients, divided into 3 groups: group I (1975-1987), group II (1988-1997), and group III (1998-2007). We observed a significant increase in age (p = 0.001), IgM and biclonal MGUS (p = 0.003), hemoglobin (p<0.0001), and albumin (p = 0.0001), and a significant reduction of monoclonal (M)-protein concentration (p<0.0001), percentage of bone marrow plasma cells (p<0.0001), and beta2-microglobulin (p = 0.0001) over the 3 decades. The proportion of patients with M-protein<1.5 g/dL was significantly higher in group III (66%) than in group II (44%) and group I (26%) (p<0.0001). By Kaplan-Meier analysis, group III had a significantly lower 5-year probability of transformation (5%) compared to group II (12%) and group I (22%) (p = 0.003). Patients with M-protein<1.5 g/dL had the same life expectancy as the general population (standardized mortality ratio 1.09; p = 0.41). In conclusion, we found that the pattern of presentation of MGUS has changed over time and now includes a higher proportion of patients with more favorable presenting features and probably a better outcome compared to patients presenting in the past. This changing scenario calls for revising the current concepts of the clinical significance of MGUS and the management of patients.
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Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. m.varettoni)smatteo.pv.it
PMID