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Prepublished online as a Blood First Edition Paper on July 24, 2003; DOI 10.1182/blood-2003-03-0801. This Article Full Text (PDF) All Versions of this Article: 2003-03-0801v1 102/10/3759    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kyle, R. A Articles by Melton, L J. Search for Related Content PubMed PubMed Citation Articles by Kyle, R. A Articles by Melton, L J. Social Bookmarking                   What's this? Submitted March 17, 2003 Accepted July 8, 2003 Long-term follow-up of IgM monoclonal gammopathy of undetermined significance Robert A Kyle*, Terry M Therneau, S Vincent Rajkumar, Ellen D Remstein, Janice R Offord, Dirk R Larson, Matthew F Plevak, and L Joseph Melton Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA Division of Biostatistics, Mayo Clinic, Rochester, MN, USA Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA Division of Epidemiology, Mayo Clinic, Rochester, MN, USA * Corresponding author; email: kyle.robert{at}mayo.edu. Little effort has been made to quantitate adverse outcomes of monoclonal gammopathy of undetermined significance (MGUS) of the IgM class, which progresses to lymphoma or Waldenstrom macroglobulinemia, whereas IgA and IgG MGUS progress to multiple myeloma, primary amyloidosis (AL), or a related plasma cell disorder. From 1960-1994, IgM MGUS was diagnosed in 213 patients in southeastern Minnesota. The end point was progression to lymphoma or a related disorder, as assessed with the Kaplan-Meier method. The 213 patients were followed for 1,567 person-years (median, 6.3 years per subject). Lymphoma developed in 17 patients (relative risk [RR], 14.8), Waldenstrom macroglobulinemia in 6 (RR, 262), primary amyloidosis in 3 (RR, 16.3), and chronic lymphocytic leukemia in 3 (RR, 5.7). The relative risk of progression was 16-fold higher in the patients with IgM MGUS than in the white population of the Iowa Surveillance, Epidemiology, and End Results Program. Cumulative incidence of progression was 10% at 5 years, 18% at 10 years, and 24% at 15 years. On multivariate analysis, the concentration of the serum monoclonal protein and level of serum albumin at diagnosis were the only risk factors for progression to lymphoma or a related disorder. 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