Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Landspítali - The National University Hospital of Iceland, Reykjavík.
Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Rigshospitalet, Copenhagen, Denmark.
Haematologica. 2024 Jul 1;109(7):2250-2255. doi: 10.3324/haematol.2023.284365.
There is some evidence that a prior cancer is a risk factor for the development of multiple myeloma (MM). If this is true, prior cancer should be associated with a higher prevalence or increased progression rate of monoclonal gammopathy of undetermined significance (MGUS), the precursor of MM and related disorders. Those with a history of cancer might therefore constitute a target population for MGUS screening. This two-part study is the first study to evaluate a relationship between MGUS and prior cancers. First, we evaluated whether prior cancers were associated with having MGUS at the time of screening in the Iceland Screens Treats or Prevents Multiple Myeloma (iStopMM) study that includes 75,422 individuals screened for MGUS. Next, we evaluated the association of prior cancer and the progression of MGUS to MM and related disorders in a population-based cohort of 13,790 Swedish individuals with MGUS. A history of prior cancer was associated with a modest increase in the risk of MGUS (odds ratio=1.10; 95% confidence interval: 1.00-1.20). This excess risk was limited to prior cancers in the year preceding MGUS screening. A history of prior cancer was associated with progression of MGUS, except for myeloid malignancies which were associated with a lower risk of progression (hazard ratio=0.37; 95% confidence interval: 0.16-0.89; P=0.028). Our findings indicate that a prior cancer is not a significant etiological factor in plasma cell disorders. The findings do not warrant MGUS screening or different management of MGUS in those with a prior cancer.
有一些证据表明,既往癌症是多发性骨髓瘤(MM)发生的危险因素。如果这是真的,那么既往癌症应该与意义未明的单克隆丙种球蛋白血症(MGUS)的患病率更高或进展速度更快有关,MGUS 是 MM 和相关疾病的前体。因此,有癌症病史的人可能构成 MGUS 筛查的目标人群。这项两部分的研究是首次评估 MGUS 与既往癌症之间关系的研究。首先,我们评估了冰岛筛查治疗或预防多发性骨髓瘤(iStopMM)研究中,在进行 MGUS 筛查时,既往癌症是否与 MGUS 相关,该研究纳入了 75422 名接受 MGUS 筛查的个体。其次,我们在一个包括 13790 名瑞典 MGUS 患者的基于人群的队列中,评估了既往癌症与 MGUS 进展为 MM 和相关疾病的相关性。既往癌症史与 MGUS 风险的适度增加相关(比值比=1.10;95%置信区间:1.00-1.20)。这种额外风险仅限于 MGUS 筛查前一年的既往癌症。既往癌症史与 MGUS 进展相关,但骨髓恶性肿瘤除外,后者与进展风险降低相关(风险比=0.37;95%置信区间:0.16-0.89;P=0.028)。我们的研究结果表明,既往癌症不是浆细胞疾病的重要病因。这些发现不支持对既往癌症患者进行 MGUS 筛查或对 MGUS 进行不同的管理。