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Role of different hematologic variables in defining the risk of malignant
transformation in monoclonal gammopathy
L Baldini, A Guffanti, BM Cesana, M Colombi, O Chiorboli, I Damilano and AT Maiolo
Servizio di Ematologia, Centro G. Marcora, Istituto di Scienze Mediche
dell'Universita di Milano, Italy.
The presenting clinico-hematologic features of 386 patients with
nonmyelomatous monoclonal gammopathy (MG) were correlated with the
frequency of malignant transformation to evaluate the most important
variables conditioning its evolution into multiple myeloma (MM) or
Waldenstrom macroglobulinemia (WM). Most of the patients (335) had
monoclonal gammopathy of undetermined significance (MGUS: 39 IgA, 242 IgG,
54 IgM): the remaining 51 patients (12 IgA, 39 IgG) fulfilled all of the
MGUS diagnostic criteria (according to Durie) except that bone marrow
plasma cell (BMPC) content was 10% to 30%, and so they were defined as
having monoclonal gammopathy of borderline significance (MGBS). There were
no significant differences between the MGUS and MGBS groups in terms of
age, sex, or median follow-up. After a median follow- up of 70 and 53
months, respectively, 23 of 335 MGUS and 19 of 51 MGBS patients had
undergone a malignant evolution. Univariate analysis of the IgA and IgG
patients showed that the cumulative probability of the disease evolving
into MM correlated with diagnostic definition (MGBS v MGUS), BMPC content
(> or = 10% v < 5% and < or = 5% v > 5%) and reduced serum
polyclonal Ig. In the IgG cases, there was also a significant correlation
with detectable Bence Jones proteinuria, serum monoclonal component (MC)
levels and age at diagnosis (> 70 v < = or 55 years). In the IgG
cases as a whole, the same variables remained in the Cox model where the
BMPC percentage was considered after natural logarithmic transformation and
the monoclonal component as g/dL value. The relative risks of developing MM
are the following: 2.4 for each 1 g/dL increase of IgG, serum MC, 3.5 for
detectable light chain proteinuria, 4.4 for the increase of 1 unit in log.
BMPC percentage, 6.1 for age > 70, 3.6 and 13.1 for a reduction in one
or two polyclonal Ig. In conclusion, our study allows the identification of
a particular subset of MGUS patients (MC < = or 1.5 g/dL, BMPC < 5%,
no reduction in polyclonal Ig and no detectable light chain proteinuria) at
very low- risk of evolution, who can be considered as having benign
monoclonal gammopathies. We also describe a previously undefined group of
MG patients (with monoclonal gammopathy of borderline significance) who are
at high-risk of malignant evolution. These findings could have a
considerable impact on the cost/benefit ratio of monitoring programs in
these patients.
Volume 87,
Issue 3,
pp. 912-918,
02/01/1996
Copyright © 1996 by The American Society of Hematology
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