Monoclonal gammopathy of undetermined significance natural history, complications and prognosis: Difference between revisions
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{{ Monoclonal gammopathy of undetermined significance }} | {{Monoclonal gammopathy of undetermined significance }} | ||
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==Natural History== | ==Natural History== | ||
==Complications== | ==Complications== | ||
*Fractures<ref name="pmid16848794">{{cite journal |vauthors=Pepe J, Petrucci MT, Nofroni I, Fassino V, Diacinti D, Romagnoli E, Minisola S |title=Lumbar bone mineral density as the major factor determining increased prevalence of vertebral fractures in monoclonal gammopathy of undetermined significance |journal=Br. J. Haematol. |volume=134 |issue=5 |pages=485–90 |date=September 2006 |pmid=16848794 |doi=10.1111/j.1365-2141.2006.06217.x |url=}}</ref><ref name="pmid14753733">{{cite journal |vauthors=Melton LJ, Rajkumar SV, Khosla S, Achenbach SJ, Oberg AL, Kyle RA |title=Fracture risk in monoclonal gammopathy of undetermined significance |journal=J. Bone Miner. Res. |volume=19 |issue=1 |pages=25–30 |date=January 2004 |pmid=14753733 |doi=10.1359/JBMR.0301212 |url=}}</ref><ref name="pmid16925792">{{cite journal |vauthors=Gregersen H, Jensen P, Gislum M, Jørgensen B, Sørensen HT, Nørgaard M |title=Fracture risk in patients with monoclonal gammopathy of undetermined significance |journal=Br. J. Haematol. |volume=135 |issue=1 |pages=62–7 |date=October 2006 |pmid=16925792 |doi=10.1111/j.1365-2141.2006.06269.x |url=}}</ref><ref name="pmid20610813">{{cite journal |vauthors=Kristinsson SY, Tang M, Pfeiffer RM, Björkholm M, Blimark C, Mellqvist UH, Wahlin A, Turesson I, Landgren O |title=Monoclonal gammopathy of undetermined significance and risk of skeletal fractures: a population-based study |journal=Blood |volume=116 |issue=15 |pages=2651–5 |date=October 2010 |pmid=20610813 |pmc=3324256 |doi=10.1182/blood-2010-04-282848 |url=}}</ref> | *Fractures specially in lumbar vertebrae<ref name="pmid16848794">{{cite journal |vauthors=Pepe J, Petrucci MT, Nofroni I, Fassino V, Diacinti D, Romagnoli E, Minisola S |title=Lumbar bone mineral density as the major factor determining increased prevalence of vertebral fractures in monoclonal gammopathy of undetermined significance |journal=Br. J. Haematol. |volume=134 |issue=5 |pages=485–90 |date=September 2006 |pmid=16848794 |doi=10.1111/j.1365-2141.2006.06217.x |url=}}</ref><ref name="pmid14753733">{{cite journal |vauthors=Melton LJ, Rajkumar SV, Khosla S, Achenbach SJ, Oberg AL, Kyle RA |title=Fracture risk in monoclonal gammopathy of undetermined significance |journal=J. Bone Miner. Res. |volume=19 |issue=1 |pages=25–30 |date=January 2004 |pmid=14753733 |doi=10.1359/JBMR.0301212 |url=}}</ref><ref name="pmid16925792">{{cite journal |vauthors=Gregersen H, Jensen P, Gislum M, Jørgensen B, Sørensen HT, Nørgaard M |title=Fracture risk in patients with monoclonal gammopathy of undetermined significance |journal=Br. J. Haematol. |volume=135 |issue=1 |pages=62–7 |date=October 2006 |pmid=16925792 |doi=10.1111/j.1365-2141.2006.06269.x |url=}}</ref><ref name="pmid20610813">{{cite journal |vauthors=Kristinsson SY, Tang M, Pfeiffer RM, Björkholm M, Blimark C, Mellqvist UH, Wahlin A, Turesson I, Landgren O |title=Monoclonal gammopathy of undetermined significance and risk of skeletal fractures: a population-based study |journal=Blood |volume=116 |issue=15 |pages=2651–5 |date=October 2010 |pmid=20610813 |pmc=3324256 |doi=10.1182/blood-2010-04-282848 |url=}}</ref> | ||
*Thromboembolic phenomena<ref name="pmid15367409">{{cite journal |vauthors=Sallah S, Husain A, Wan J, Vos P, Nguyen NP |title=The risk of venous thromboembolic disease in patients with monoclonal gammopathy of undetermined significance |journal=Ann. Oncol. |volume=15 |issue=10 |pages=1490–4 |date=October 2004 |pmid=15367409 |doi=10.1093/annonc/mdh385 |url=}}</ref> | |||
*Hypercoaguable state | |||
* | |||
==Prognosis== | ==Prognosis== | ||
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* The annual risk of progressing to multiple myeloma is around 1–2% a year. Kyle ''et al'' studied the prevalence of myeloma in a population-wide cohort in Olmsted County, Minnesota. They found that the prevalence of MGUS was 3.2% in people above 50, with a slight male predominance (4.0% vs. 2.7%). Prevalence increased with age: of people over 70 up to 5.3% had MGUS, while in the over-85 age group the prevalence was 7.5%. In the majority of cases (63.5%), the paraprotein level was <1 g/dl, while only a very small group had levels over 2 g/dl.<ref name="Kyle">{{cite journal | author=Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR, Dispenzieri A, Katzmann JA, Melton LJ 3rd. | title=Prevalence of monoclonal gammopathy of undetermined significance | journal=N Engl J Med | year=2006 | month=28 December | volume=354| pages=1362-9 | id=PMID 16571879}}</ref> | * The annual risk of progressing to multiple myeloma is around 1–2% a year. Kyle ''et al'' studied the prevalence of myeloma in a population-wide cohort in Olmsted County, Minnesota. They found that the prevalence of MGUS was 3.2% in people above 50, with a slight male predominance (4.0% vs. 2.7%). Prevalence increased with age: of people over 70 up to 5.3% had MGUS, while in the over-85 age group the prevalence was 7.5%. In the majority of cases (63.5%), the paraprotein level was <1 g/dl, while only a very small group had levels over 2 g/dl.<ref name="Kyle">{{cite journal | author=Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR, Dispenzieri A, Katzmann JA, Melton LJ 3rd. | title=Prevalence of monoclonal gammopathy of undetermined significance | journal=N Engl J Med | year=2006 | month=28 December | volume=354| pages=1362-9 | id=PMID 16571879}}</ref> | ||
* In addition to multiple myeloma, MGUS may also progress to [[Waldenström's macroglobulinemia]], primary [[amyloidosis]], [[B-cell lymphoma]], or[[chronic lymphocytic leukemia]]. <font color="#777777"> | * In addition to multiple myeloma, MGUS may also progress to [[Waldenström's macroglobulinemia]], primary [[amyloidosis]], [[B-cell lymphoma]], or[[chronic lymphocytic leukemia]]. <font color="#777777">'</font> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Complications
- Fractures specially in lumbar vertebrae[1][2][3][4]
- Thromboembolic phenomena[5]
- Hypercoaguable state
Prognosis
- MGUS may be considered a pre-malignant condition, given the possibility of transformation into multiple myeloma. However, because the condition tends to occur in the elderly, and because the rate of progression is slow, only a small proportion of people with MGUS go on to develop ahaematological malignancy. In patients with MGUS, although the actuarial risk of myeloma at 25 years of follow-up is 30%, the actual risk (when competing causes of death are taken into account) is only 11%.[6]
- The annual risk of progressing to multiple myeloma is around 1–2% a year. Kyle et al studied the prevalence of myeloma in a population-wide cohort in Olmsted County, Minnesota. They found that the prevalence of MGUS was 3.2% in people above 50, with a slight male predominance (4.0% vs. 2.7%). Prevalence increased with age: of people over 70 up to 5.3% had MGUS, while in the over-85 age group the prevalence was 7.5%. In the majority of cases (63.5%), the paraprotein level was <1 g/dl, while only a very small group had levels over 2 g/dl.[7]
- In addition to multiple myeloma, MGUS may also progress to Waldenström's macroglobulinemia, primary amyloidosis, B-cell lymphoma, orchronic lymphocytic leukemia. '
References
- ↑ Pepe J, Petrucci MT, Nofroni I, Fassino V, Diacinti D, Romagnoli E, Minisola S (September 2006). "Lumbar bone mineral density as the major factor determining increased prevalence of vertebral fractures in monoclonal gammopathy of undetermined significance". Br. J. Haematol. 134 (5): 485–90. doi:10.1111/j.1365-2141.2006.06217.x. PMID 16848794.
- ↑ Melton LJ, Rajkumar SV, Khosla S, Achenbach SJ, Oberg AL, Kyle RA (January 2004). "Fracture risk in monoclonal gammopathy of undetermined significance". J. Bone Miner. Res. 19 (1): 25–30. doi:10.1359/JBMR.0301212. PMID 14753733.
- ↑ Gregersen H, Jensen P, Gislum M, Jørgensen B, Sørensen HT, Nørgaard M (October 2006). "Fracture risk in patients with monoclonal gammopathy of undetermined significance". Br. J. Haematol. 135 (1): 62–7. doi:10.1111/j.1365-2141.2006.06269.x. PMID 16925792.
- ↑ Kristinsson SY, Tang M, Pfeiffer RM, Björkholm M, Blimark C, Mellqvist UH, Wahlin A, Turesson I, Landgren O (October 2010). "Monoclonal gammopathy of undetermined significance and risk of skeletal fractures: a population-based study". Blood. 116 (15): 2651–5. doi:10.1182/blood-2010-04-282848. PMC 3324256. PMID 20610813.
- ↑ Sallah S, Husain A, Wan J, Vos P, Nguyen NP (October 2004). "The risk of venous thromboembolic disease in patients with monoclonal gammopathy of undetermined significance". Ann. Oncol. 15 (10): 1490–4. doi:10.1093/annonc/mdh385. PMID 15367409.
- ↑ Bladé J (2006). "Clinical practice. Monoclonal gammopathy of undetermined significance". N Engl J Med. 355 (26): 2765–70. PMID 17192542 Abstract.
- ↑ Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR, Dispenzieri A, Katzmann JA, Melton LJ 3rd. (2006). "Prevalence of monoclonal gammopathy of undetermined significance". N Engl J Med. 354: 1362–9. PMID 16571879. Unknown parameter
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