Malignant transformation of monoclonal gammopathy of undetermined significance among out‐patients of a community hospital in Southeastern Netherlands
Malignant transformation of monoclonal gammopathy of undetermined significance among out‐patients of a community hospital in Southeastern Netherlands
复制标题
荷兰东南部社区医院门诊患者中意义未定的单克隆丙种球蛋白病的恶性转化
DOI：
10.1111/j.1365-2141.1995.tb05256.x
复制
发表时间：
1995
影响因子：
6.5
通讯作者：
H. Hillen
中科院分区：
文献类型：
--
作者：
M. Poel;J. Coebergh;H. Hillen
单克隆伽玛病患者在一年内没有淋巴细胞增生性或浆细胞恶性肿瘤的证据，仍有恶性转化为多发性骨髓瘤、瓦尔登斯特罗姆大球蛋白血症或非霍奇金淋巴瘤的风险。在梅奥诊所进行的一项前瞻性研究中，14年内恶性转化的累积发生率为29%。我们进行了一项回顾性研究，以确定来自荷兰东南部一家社区医院的334名未选择的未确定意义的单克隆伽玛病（MGUS）患者的恶性转化频率。14年内恶性转化的累积发生率为11%（95%可信区间为6-17%）。MGUS患者的长期生存率略低于地区平均人群。在一项巢式病例对照研究中，kappa轻链的存在被发现是恶性转化的一个危险因素（70%的患者发生恶性转化，而对照组为30%，P < 001）。同样，最初的高γ球蛋白水平也被发现是一个危险因素（对照组为18-7g / 1v 13-7g /l， P<001）。由于这两种危险因素之前都没有被描述过，因此这些因素在单克隆γ病患者中定义高风险群体的意义仍有待确定。
Summary Patients with a monoclonal gammopathy without evidence of lymphoproliferative or plasma cell malignancy within a year are still at risk for malignant transformation to multiple myeloma, Waldenstrom's macro‐globulinaemia or non‐Hodgkin's lymphoma. In a prospective study performed at the Mayo Clinic, the cumulative incidence of malignant transformation was 29% in 14 years. We conducted a retrospective study to determine the frequency of malignant transformation among 334 un‐selected out‐patients with monoclonal gammopathy of undetermined significance (MGUS) from a community hospital in Southeastern Netherlands. The cumulative incidence of malignant transformation was 11% in 14 years (95% confidence interval 6–17%). The long‐term survival of patients with MGUS was slightly lower than that of the average regional population. In a nested case‐control study, presence of a kappa light chain was found to be a risk factor for malignant transformation (70% of patients who developed malignant transformation compared to 30% of the control group, P < 001). Likewise, an initial high gamma globulin level was also found to be a risk factor (18–7g/1 v 13–7g/l in the control group, P<001). As neither risk factor has been described before, the significance of these factors for definition of a high‐risk group among patients with monoclonal gammopathy remains to be determined.