Presenting features of monoclonal gammopathies

An analysis of 684 newly diagnosed cases

G. Ucci, A. Riccardi, R. Luoni, E. Ascari

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objectives. The clinical, laboratory and radiologic features at diagnosis of 684 newly diagnosed patients with monoclonal gammopathy were revised in order to underline the differences between monoclonal gammopathies of undetermined significance (MGUS) and stage I multiple myeloma (MM). Design. Patients were screened for inclusion in a prospective controlled protocol for treatment of MM. Those having serum or urine monoclonal component (MC) were diagnosed as MM when they demonstrated osteolysis and/or bone marrow plasma cells (BMPC) > 20%; patients not fulfilling these criteria were considered MGUS. Setting. Patients were recruited from 24 general or university hospitals from the departments of internal medicine, haematology and medical oncology. Subjects. Seven-hundred-and-fifty were enrolled between January 1986 and March 1990; 684 (343 MGUS and 341 MM) were able to be evaluated for this study and 78 were stage I MM. Interventions. Complete clinical, radiologic and laboratory work-up was carried out at the referral centres. Main outcome measures. The main outcome expected was the confirmation that BMPC > 20% could reliably differentiate stage I MM from MGUS. Results. At a median follow-up of 36 months (minimum follow-up: 18 months), MGUS had a lower progression rate to overt MM, longer overall survival and different causes of death than stage I MM. Further differences concerned erythrocyte sedimentation rate (28 vs. 47, P <0.001), per cent reduction of normal immunoglobulin (86 vs. 60%, P <0.001), serum MC (1.6 vs. 2.2 g dl-1, P <0.001) and thymidine kinase level (3.3 vs. 4.5 mU ml-1, P <0.05). Conclusions. The study suggests that 20% BMPC can be taken as a safe cut-off point at which to differentiate MGUS from early MM and outlines a few simple parameters which can be of diagnostic aid.

Original languageEnglish
Pages (from-to)165-173
Number of pages9
JournalJournal of Internal Medicine
Volume234
Issue number2
Publication statusPublished - 1993

Fingerprint

Paraproteinemias
Multiple Myeloma
Monoclonal Gammopathy of Undetermined Significance
Plasma Cells
Bone Marrow Cells
Osteolysis
Medical Oncology
Thymidine Kinase
Blood Sedimentation
Hospital Departments
Hematology
Internal Medicine
Clinical Protocols
Serum
General Hospitals
Immunoglobulins
Cause of Death
Referral and Consultation
Outcome Assessment (Health Care)
Urine

Keywords

  • monoclonal gammopathy
  • multiple myeloma
  • presenting features

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Presenting features of monoclonal gammopathies : An analysis of 684 newly diagnosed cases. / Ucci, G.; Riccardi, A.; Luoni, R.; Ascari, E.

In: Journal of Internal Medicine, Vol. 234, No. 2, 1993, p. 165-173.

Research output: Contribution to journalArticle

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abstract = "Objectives. The clinical, laboratory and radiologic features at diagnosis of 684 newly diagnosed patients with monoclonal gammopathy were revised in order to underline the differences between monoclonal gammopathies of undetermined significance (MGUS) and stage I multiple myeloma (MM). Design. Patients were screened for inclusion in a prospective controlled protocol for treatment of MM. Those having serum or urine monoclonal component (MC) were diagnosed as MM when they demonstrated osteolysis and/or bone marrow plasma cells (BMPC) > 20{\%}; patients not fulfilling these criteria were considered MGUS. Setting. Patients were recruited from 24 general or university hospitals from the departments of internal medicine, haematology and medical oncology. Subjects. Seven-hundred-and-fifty were enrolled between January 1986 and March 1990; 684 (343 MGUS and 341 MM) were able to be evaluated for this study and 78 were stage I MM. Interventions. Complete clinical, radiologic and laboratory work-up was carried out at the referral centres. Main outcome measures. The main outcome expected was the confirmation that BMPC > 20{\%} could reliably differentiate stage I MM from MGUS. Results. At a median follow-up of 36 months (minimum follow-up: 18 months), MGUS had a lower progression rate to overt MM, longer overall survival and different causes of death than stage I MM. Further differences concerned erythrocyte sedimentation rate (28 vs. 47, P <0.001), per cent reduction of normal immunoglobulin (86 vs. 60{\%}, P <0.001), serum MC (1.6 vs. 2.2 g dl-1, P <0.001) and thymidine kinase level (3.3 vs. 4.5 mU ml-1, P <0.05). Conclusions. The study suggests that 20{\%} BMPC can be taken as a safe cut-off point at which to differentiate MGUS from early MM and outlines a few simple parameters which can be of diagnostic aid.",
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