Definition and Clinical Significance of the Monoclonal Gammopathy of Undetermined Significance-Like Phenotype in Patients With Monoclonal Gammopathies
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
36930848
DOI
10.1200/jco.22.01916
Knihovny.cz E-resources
- MeSH
- Phenotype MeSH
- Clinical Relevance MeSH
- Humans MeSH
- Multiple Myeloma * diagnosis MeSH
- Monoclonal Gammopathy of Undetermined Significance * diagnosis therapy MeSH
- Paraproteinemias * diagnosis therapy MeSH
- Immunoglobulin Light-chain Amyloidosis * MeSH
- Disease Progression MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
PURPOSE: The existence of patients with multiple myeloma (MM) and light-chain (AL) amyloidosis who present with a monoclonal gammopathy of undetermined significance (MGUS)-like phenotype has been hypothesized, but methods to identify this subgroup are not standardized and its clinical significance is not properly validated. PATIENTS AND METHODS: An algorithm to identify patients having MGUS-like phenotype was developed on the basis of the percentages of total bone marrow (BM) plasma cells (PC) and of clonal PC within the BM PC compartment, determined at diagnosis using flow cytometry in 548 patients with MGUS and 2,011 patients with active MM. The clinical significance of the algorithm was tested and validated in 488 patients with smoldering MM, 3,870 patients with active MM and 211 patients with AL amyloidosis. RESULTS: Patients with smoldering MM with MGUS-like phenotype showed significantly lower rates of disease progression (4.5% and 0% at 2 years in two independent series). There were no statistically significant differences in time to progression between treatment versus observation in these patients. In active newly diagnosed MM, MGUS-like phenotype retained independent prognostic value in multivariate analyses of progression-free survival (PFS; hazard ratio [HR], 0.49; P = .001) and overall survival (OS; HR, 0.56; P = .039), together with International Staging System, lactate dehydrogenase, cytogenetic risk, transplant eligibility, and complete remission status. Transplant-eligible patients with active MM with MGUS-like phenotype showed PFS and OS rates at 5 years of 79% and 96%, respectively. In this subgroup, there were no differences in PFS and OS according to complete remission and measurable residual disease status. Application of the algorithm in two independent series of patients with AL predicted for different survival. CONCLUSION: We developed an open-access algorithm for the identification of MGUS-like patients with distinct clinical outcomes. This phenotypic classification could become part of the diagnostic workup of MM and AL amyloidosis.
4th Department of Medicine Haematology Charles University Hospital Hradec Králové Czech Republic
Department of Haematooncology University Hospital Ostrava Ostrava Czech Republic
Department of Hematology University Hospital Vall d'Hebron Barcelona Spain
Hematology Department Hospital Costa del Sol Marbella Marbella Spain
Hematology Department University Hospital La Fe Valencia Spain
Hospital Clínico San Carlos Madrid Spain
Hospital Clínico Universitario Lozano Blesa Zaragoza Spain
Hospital Clínico Universitario Virgen de la Arrixaca IMIB Arrixaca University of Murcia Murcia Spain
Hospital de Cabueñes Gijón Spain
Hospital Morales Meseguer IMIB Arrixaca Universidad de Murcia Murcia Spain
Hospital Universitario de Canarias Santa Cruz de Tenerife Spain
Hospital Universitario de Salamanca CIBERONC Salamanca Spain
Hospital Universitario La Fe Valencia Spain
Hospital Universitario Puerta de Hierro Hospital Madrid Spain
Hospital Universitario Son Espases Palma Spain
Tom Baker Cancer Center Department of Hematology University of Calgary Calgary AB Canada
References provided by Crossref.org
Real-World Evidence on Prognostic Value of MRD in Multiple Myeloma Using Flow Cytometry
