Rosinol et al identified predictors for malignant transformation in a patient with monoclonal gammopathy of undetermined significance (MGUS). These can help to identify a patient who may benefit from closer monitoring. The authors are from the University of Barcelona.
Patient selection: monoclonal gammopathy of undetermined significance (MGUS)
Outcome: progression to multiple myeloma or Waldenstrom's macroglobulinemia
Predictors of disease progression:
(1) monoclonal protein concentration >= 15 g/L (1.5 g/dL; odds ratio 2.2)
(2) evolving pattern (progressive increase in the monoclonal protein concentration in each consecutive year in the 3 years from baseline; odds ratio 12.1))
(3) IgA monoclonal protein (odds ratio 2.9)
Nonevolving monoclonal pattern: monoclonal protein concentration unchanged
This implies that there could be an intermediate pattern between the nonevolving and evolving patterns).
Progression
Evolving
Nonevolving
in 10 years
55%
10%
in 20 years
80%
13%
Bone marrow plasma cells >= 5% was associated with progression but the p value was 0.25.
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