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Medline ® Abstract for Reference 31

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

Changing pattern of presentation in monoclonal gammopathy of undetermined significance: a single-center experience with 1400 patients.
Varettoni M, Corso A, Cocito F, Mangiacavalli S, Pascutto C, Zappasodi P, Pica G, Lazzarino M
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.
Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy. m.varettoni)smatteo.pv.it