Long-term follow-up of a population based cohort with monoclonal proteinaemia.

Department of Internal Medicine, Gelre Hospitals, Lukas location, Apeldoorn, The Netherlands.
British Journal of Haematology (Impact Factor: 4.96). 12/2008; 144(2):176-84. DOI: 10.1111/j.1365-2141.2008.07423.x
Source: PubMed

ABSTRACT Prospective studies on the risk of malignant transformation in patients with monoclonal gammopathy of undetermined significance (MGUS) and factors predictive of survival are lacking. The Dutch Comprehensive Cancer Centre West, comprising 1.6 million inhabitants, initiated a prospective hospital-based cohort study on 1464 patients with newly diagnosed M-proteinaemia, median age 73 (17-103) years. M-protein related diagnoses, patients' characteristics, laboratory investigations, bone marrow examinations and skeletal X-rays were registered with a yearly follow-up. Main endpoints were death, or new diagnoses of multiple myeloma and non-Hodgkin lymphoma. Kaplan-Meier survival curves were compared with age- and gender-matched survival data from the total Dutch population. Cumulative malignant transformation was corrected for death using a competing risk model. Risk factors for transformation or death were analyzed by univariate and multivariate analyses. In 1007 MGUS-patients, malignant transformation was associated with rising M-protein levels, IgA and IgM isotype and occurred at a yearly rate of 0.4%. All MGUS patients survived less than a matched cohort of the Dutch population, even in the absence of M-protein-associated comorbidity. Serum albumin levels at entry appeared highly predictive for survival. M-proteinaemia is not an innocent symptom. Although malignant transformation occurs rarely, survival is shortened irrespective of comorbidity.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Monoclonal gammopathy of undetermined significance (MGUS) of IgM type is the strongest risk factor for the development of Waldenström macroglobulinemia (WM). The clinical management of WM has changed considerably over recent years, which is reflected in the use of new therapeutic agents (eg, purine analogues, monoclonal antibodies, and thalidomide- and bortezomib-based therapies), risk-and-response-adjusted stratification of treatments, and improvement in supportive care measures. However, because of the rarity of WM, there are few phase III randomized clinical studies to guide therapy and evaluate overall survival. In this review, we discuss the current knowledge on prognosis, survival patterns, and causes of death in individuals with MGUS. In addition, we discuss clinical studies as well as recent population-based studies on WM, with a focus on treatment, prognostic factors, and survival. Finally, new agents and future perspectives in these disorders are reviewed.
    Clinical lymphoma, myeloma & leukemia 03/2013; DOI:10.1016/j.clml.2013.02.010 · 1.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The task of detection of specific buried objects in ground penetrating radar (GPR) images is considered. A modification of the Hough transform (HT) is proposed and applied to this problem. Methods of texture analysis are used to determine the soil structure. The possibility of gaining information about the material of the buried object is examined. The results of some experiments with GPR imagery are shown and discussed
    Geoscience and Remote Sensing Symposium, 1993. IGARSS '93. Better Understanding of Earth Environment., International; 09/1993
  • [Show abstract] [Hide abstract]
    ABSTRACT: Monoclonal gammopathy of undetermined significance is one of the most common premalignant disorders. IgG and IgA monoclonal gammopathy of undetermined significance are precursor conditions of multiple myeloma; light-chain monoclonal gammopathy of undetermined significance of light-chain multiple myeloma; and IgM monoclonal gammopathy of undetermined significance of Waldenstrom macroglobulinemia and other lymphoproliferative disorders. Clonal burden, as determined by bone marrow plasma cell percentage or M-protein level, as well as biological characteristics, including heavy chain isotype and light chain production, are helpful in predicting risk of progression of monoclonal gammopathy of undetermined significance to symptomatic disease. Furthermore, alterations in the bone marrow microenvironment of monoclonal gammopathy of undetermined significance patients, result in an increased risk of venous and arterial thrombosis, infections, osteoporosis, and bone fractures. In addition, the small clone may occasionally be responsible for severe organ damage through the production of a monoclonal protein which has autoantibody activity or deposits in tissues. These disorders are rare and often require therapy directed at eradication of the underlying plasma cell or lymphoplasmacytic clone. In this review, we provide an overview of the clinical relevance of monoclonal gammopathy of undetermined significance. We also give general recommendations of how to diagnose and manage patients with monoclonal gammopathy of undetermined significance.
    Haematologica 03/2014; 99(6). DOI:10.3324/haematol.2013.100552 · 5.87 Impact Factor