A long-term study of prognosis in monoclonal gammopathy of undetermined significance
A long-term study of prognosis in monoclonal gammopathy of undetermined significance
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DOI：
10.1056/nejmoa01133202
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发表时间：
2002-02-21
影响因子：
158.5
通讯作者：
Melton, L
中科院分区：
文献类型：
--
作者：
Kyle, RA;Therneau, TM;Melton, L
背景：在50岁或以上的人群中，高达2%的人患有未确定意义的单克隆γ病（MGUS）。可靠的进展预测因素尚未确定，而且有关预后的信息有限。方法：我们确定了1384例居住在明尼苏达州东南部的患者，这些患者从1960年到1994年在梅奥诊所被诊断为MGUS。主要终点是进展为多发性骨髓瘤或其他浆细胞癌。结果：在11,009人年的随访期间，1384例患者中有115例MGUS进展为多发性骨髓瘤、IgM淋巴瘤、原发性淀粉样变性、巨球蛋白血症、慢性淋巴细胞白血病或浆细胞瘤（进展的相对风险分别为25.0、2.4、8.4、46.0、0.9和8.5）。与爱荷华州监测、流行病学和最终结果项目的白人人群相比，这些患者进展的总体相对风险为7.3。在另外32例患者中，单克隆蛋白浓度增加到每分升3克以上，或者骨髓中浆细胞的百分比增加到10%以上（阴燃型多发性骨髓瘤），但没有进展为明显的骨髓瘤或相关疾病。10年的累积进展概率为12%，20年为25%，25年为30%。血清单克隆蛋白的初始浓度是20年病情进展的重要预测因子。结论：MGUS进展为多发性骨髓瘤或相关疾病的风险约为每年1%。版权所有(C) 2002马萨诸塞州医学协会。
Background: A monoclonal gammopathy of undetermined significance (MGUS) occurs in up to 2 percent of persons 50 years of age or older. Reliable predictors of progression have not been identified, and information on prognosis is limited.Methods: We identified 1384 patients residing in southeastern Minnesota in whom MGUS was diagnosed at the Mayo Clinic from 1960 through 1994. The primary end point was progression to multiple myeloma or another plasma-cell cancer.Results: During 11,009 person-years of follow-up, MGUS progressed in 115 of the 1384 patients to multiple myeloma, IgM lymphoma, primary amyloidosis, macroglobulinemia, chronic lymphocytic leukemia, or plasmacytoma (relative risk of progression, 25.0, 2.4, 8.4, 46.0, 0.9, and 8.5, respectively). The overall relative risk of progression was 7.3 in these patients as compared with the white population of the Iowa Surveillance, Epidemiology, and End Results program. In 32 additional patients, the monoclonal protein concentration increased to more than 3 g per deciliter or the percentage of plasma cells in the bone marrow increased to more than 10 percent (smoldering multiple myeloma) but without progression to overt myeloma or related disorders. The cumulative probability of progression was 12 percent at 10 years, 25 percent at 20 years, and 30 percent at 25 years. The initial concentration of serum monoclonal protein was a significant predictor of progression at 20 years.Conclusions: The risk of progression of MGUS to multiple myeloma or related disorders is about 1 percent per year. Copyright (C) 2002 Massachusetts Medical Society.