Role of different hematologic variables in defining the risk of malignant transformation in monoclonal gammopathy
Role of different hematologic variables in defining the risk of malignant transformation in monoclonal gammopathy
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DOI：
10.1182/blood.v87.3.912.bloodjournal873912
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发表时间：
1996-02-01
期刊：
影响因子：
20.3
通讯作者：
Maiolo, AT
中科院分区：
文献类型：
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作者：
Baldini, L;Guffanti, A;Maiolo, AT
386 名非骨髓瘤性单克隆丙种球蛋白病 (MG) 患者的临床血液学特征与恶性转化频率相关，以评估影响其演变为多发性骨髓瘤 (MM) 或华氏巨球蛋白血症 (WM) 的最重要变量。大多数患者（335 名）患有意义未明的单克隆丙种球蛋白病（MGUS：39 例 IgA、242 例 IgG、54 例 IgM）；其余51例患者（12例IgA，39例IgG）除骨髓浆细胞（BMPC）含量为10%～30%外，均符合MGUS诊断标准（居里）的所有诊断标准，因此被定义为具有临界意义的单克隆丙种球蛋白病（MGBS）。 MGUS 组和 MGBS 组在年龄、性别或中位随访时间方面没有显着差异。中位随访时间分别为 70 个月和 53 个月后，335 名 MGUS 患者中的 23 名和 51 名 MGBS 患者中的 19 名经历了恶性演变。对 IgA 和 IgG 患者的单变量分析显示，疾病演变为 MM 的累积概率与诊断定义（MGBS vs MGUS）、BMPC 含量（大于或等于 10% vs 5%）和血清多克隆 Ig 降低相关。在 IgG 病例中，与可检测的 Bence Jones 蛋白尿、血清单克隆成分 (MC) 水平和诊断时年龄（>70 v 小于或等于 55 岁）也存在显着相关性。在整个 IgG 病例中，Cox 模型中保留了相同的变量，其中在自然对数变换后考虑 BMPC 百分比，并将单克隆成分视为 g/dL 值。发生 MM 的相对风险如下：IgG 血清 MC 每增加 1 g/dL，风险为 2.4；可检测到的轻链蛋白尿，风险为 3.5；对数增加 1 个单位，风险为 4.4。 BMPC 百分比，年龄 >70 时为 6.1，一或两种多克隆 Ig 减少时为 3.6 和 13.1。总之，我们的研究可以识别 MGUS 患者的特定子集（MC 小于或等于 1.5 g/dL、BMPC
The presenting clinico-hematologic features of 386 patients with nonmyelomatous monoclonal gammopathy (MG) were correlated with the frequency of malignant transformation to evaluate the most important variables conditioning its evolution into multiple myeloma (MM) or Waldenstrom macroglobulinemia (WM). Most of the patients (335) had monoclonal gammopathy of undetermined significance (MGUS: 39 IgA, 242 IgG, 54 IgM); the remaining 51 patients (12 IgA, 39 IgG) fulfilled all of the MGUS diagnostic criteria (according to Curie) except that bone marrow plasma cell (BMPC) content was 10% to 30%, and so they were defined as having monoclonal gammopathy of borderline significance (MGBS). There were no significant differences between the MGUS and MGBS groups in terms of age, sex, or median follow-up. After a median follow-up of 70 and 53 months, respectively, 23 of 335 MGUS and 19 of 51 MGBS patients had undergone a malignant evolution. Univariate analysis of the IgA and IgG patients showed that the cumulative probability of the disease evolving into MM correlated with diagnostic definition (MGBS v MGUS), BMPC content (greater than or equal to 10% v 5%) and reduced serum polyclonal Ig. In the IgG cases, there was also a significant correlation with detectable Bence Jones proteinuria, serum monoclonal component (MC) levels and age at diagnosis (>70 v less than or equal to 55 years). In the IgG cases as a whole, the same variables remained in the Cox model where the BMPC percentage was considered after natural logarithmic transformation and the monoclonal component as g/dL value. The relative risks of developing MM are the following: 2.4 for each 1 g/dL increase of IgG serum MC, 3.5 for detectable light chain proteinuria, 4.4 for the increase of 1 unit in log. BMPC percentage, 6.1 for age >70, 3.6 and 13.1 for a reduction in one or two polyclonal Ig. In conclusion, our study allows the identification of a particular subset of MGUS patients (MC less than or equal to 1.5 g/dL, BMPC