Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Leukemia. 2019 May;33(5):1273-1277. doi: 10.1038/s41375-019-0419-7. Epub 2019 Feb 20.
Multiple myeloma (MM) is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS), smoldering myeloma (SMM), or solitary plasmacytoma (SPC). There is a lack of data regarding impact of these pre-existing monoclonal gammopathies (MGs) on MM outcomes. Patients with prior diagnosis of MGUS, SMM, or PC from 1973 to 2015 (cases) were identified from our institution's database and compared to those without a known MG (controls). The primary outcome of interest was overall survival (OS). Multivariate analysis was performed to ascertain factors impacting all-cause mortality. We identified 774 patients with a prior diagnosis of MGUS, SMM or SPC (cases) and a control population (1:2) matched for the year of diagnosis (n = 1548). After a median follow-up of 81 months, the cases showed a longer median OS than the controls (71 months vs. 56 months). The improved OS was limited to those with a known prior diagnosis of SMM (80 months) and SPC (95 months), compared to MGUS (60 months). Multivariable analysis revealed that MM patients with known prior MG had less overall mortality than those without, and this was limited to prior SMM/SPC group (HR 0.68, 95% CI: 0.50-0.93), as compared to the MGUS group (HR 0.83, 95% CI: 0.66-1.05).
多发性骨髓瘤（MM）通常先于意义未明的单克隆丙种球蛋白血症（MGUS）、冒烟型骨髓瘤（SMM）或孤立性浆细胞瘤（SPC）。关于这些预先存在的单克隆丙种球蛋白（MG）对 MM 结果的影响，数据有限。从我们机构的数据库中确定了 1973 年至 2015 年期间患有先前诊断的 MGUS、SMM 或 PC 的患者（病例），并将其与无已知 MG 的患者（对照）进行比较。主要观察终点为总生存期（OS）。进行多变量分析以确定影响全因死亡率的因素。我们确定了 774 例患有先前诊断的 MGUS、SMM 或 SPC（病例）的患者和按诊断年份（n=1548）匹配的对照人群（1:2）。中位随访 81 个月后，病例的中位 OS 长于对照组（71 个月比 56 个月）。这种改善的 OS 仅限于已知有 SMM（80 个月）和 SPC（95 个月）先前诊断的患者，而不是 MGUS（60 个月）。多变量分析显示，与无已知先前 MG 的 MM 患者相比，已知有先前 MG 的 MM 患者的总死亡率较低，且仅限于先前 SMM/SPC 组（HR 0.68，95%CI：0.50-0.93），而不是 MGUS 组（HR 0.83，95%CI：0.66-1.05）。
