A monoclonal gammopathy precedes multiple myeloma in most patients

被引:428
作者
Weiss, Brendan M. [1 ]
Abadie, Jude [2 ,3 ]
Verma, Pramvir [4 ]
Howard, Robin S. [5 ]
Kuehl, W. Michael [6 ]
机构
[1] Walter Reed Army Med Ctr, Hematol Oncol Serv, Dept Med, Washington, DC 20307 USA
[2] Walter Reed Army Med Ctr, Dept Pathol, Washington, DC 20307 USA
[3] Walter Reed Army Med Ctr, Area Lab Serv, Washington, DC 20307 USA
[4] Womack Army Med Ctr, Hematol Oncol Serv, Dept Med, Ft Bragg, NC USA
[5] Walter Reed Army Med Ctr, Dept Clin Invest, Washington, DC 20307 USA
[6] NCI, Genet Branch, Ctr Canc Res, Bethesda, MD 20892 USA
基金
美国国家卫生研究院;
关键词
UNDETERMINED SIGNIFICANCE MGUS; INDEPENDENT RISK-FACTOR; LIGHT-CHAIN RATIO; LONG-TERM; FOLLOW-UP; PROGRESSION; PROGNOSIS; SURVIVAL;
D O I
10.1182/blood-2008-12-195008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Preexisting plasma cell disorders, monoclonal gammopathy of undetermined significance, or smoldering myeloma are present in at least one-third of multiple myeloma patients. However, the proportion of patients with a preexisting plasma cell disorder has never been determined by laboratory testing on prediagnostic sera. We cross-referenced our autologous stem cell transplantation database with the Department of Defense Serum Repository. Serum protein electrophoresis, immunofixation electrophoresis, and serum free light-chain analysis were performed on all sera collected 2 or more years before diagnosis to detect a monoclonal gammopathy (M-Ig). In 30 of 90 patients, 110 prediagnostic samples were available from 2.2 to 15.3 years before diagnosis. An M-Ig was detected initially in 27 of 30 patients (90%, 95% confidence interval, 74%-97%); by serum protein electrophoresis and/or immunofixation electrophoresis in 21 patients (77.8%), and only by serum free lightchain analysis in 6 patients (22.2%). Four patients had only one positive sample within 4 years before diagnosis, with all preceding sera negative. All 4 patients with light-chain/nonsecretory myeloma evolved from a light-chain M-Ig. A preexisting M-Ig is present in most multiple myeloma patients before diagnosis. Some patients progress rapidly through a premalignant phase. Light-chain detected M-Ig is a new entity that requires further study. (Blood. 2009; 113: 5418-5422)
引用
收藏
页码:5418 / 5422
页数:5
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