Turesson et al studied factors predictive of disease progression for a patient with monoclonal gammopathy of unknown significance (MGUS). This can help to identify a patient who may require more aggressive follow-up and management. The authors are from Skane University Hospital, National Cancer Institute, Landspitali National University Hospital, and the University of Birmingham.
Patient selection: monoclonal protein of undetermine significance (MGUS)
Risk factors of Rajkumar et al (Mayo Clinic factors):
(1) free light chain ratio < 0.26 or > 1.65
(2) monoclonal protein not IgG
(3) monoclonal protein concentration >= 1.5 g/dL
An additional risk factor is immunoparesis (depression of the concentration of noninvolved immunoglobulin types).
Monoclonal Protein
IgA
IgG
IgM
IgG
< 0.88 g/L
NA
< 0.27 g/L
IgA
NA
< 6.7 g/L
< 0.27 g/L
IgM
< 0.88 g/L
< 6.7 g/L
NA
risk score for progression to a lymphoid malignancy =
= SUM(3 Mayo risk factors) + (immunoparesis, 1 if present, 0 if absent)
Interpretation:
• minimum risk score: 0
• maximum risk score: 4
• The higher the score the greater the risk of disease progression.
Risk Score
20 Year Risk of Lymphoid Malignancy
0
3.8%
1
7.8%
2
13.6%
3
25.6%
4
> 90%
The 30-year cumulative risk for development of a myeloid malignancy was less than 2%.
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