Proposal and validation of prognostic scoring systems for IgG and IgA monoclonal gammopathies of undetermined significance

Francesca Rossi, Maria Teresa Petrucci, Andrea Guffanti, Luigi Marcheselli, Davide Rossi, Vincenzo Callea, Federico Vincenzo, Marianna De Muro, Alessandra Baraldi, Oreste Villani, Pellegrino Musto, Andrea Bacigalupo, Gianluca Gaidano, Giuseppe Avvisati, Maria Goldaniga, Lorenzo DePaoli, Luca Baldini

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose:The presenting clinico-hematologic features of1,283 patientswith IgGand IgAmonoclonal gammopathies of undetermined significance (MGUS) were correlated with the frequency of evolution into multiple myeloma (MM). Experimental Design: Two IgGMGUS populations were evaluated: a training sample (553 patients) and a test sample (378 patients); the IgAMGUS population consisted of 352 patients. Results: Forty-seven of the 553 training group patients and 22 of 378 test group IgG patients developed MMafter a median follow-up of 6.7 and 3.6 years, respectively. Multivariate analysis showed that serum monoclonal component (MC) levels of ≤1.5 g/dL, the absence of light-chain proteinuria and normal serumpolyclonal immunoglobulinlevels defined a prognostically favorable subset of patients, and could be used to stratify the patients into three groups at different10-year risk of evolution (hazard ratio, 1.0, 5.04, 11.2; P < 0.001).This scoring system was validated in the test sample.Thirty of the 352 IgA patients developed MMafter a median follow-up of 4.8 years, and multivariate analysis showed that hemoglobin levels of <12.5 g/dL and reduced serumpolyclonal immunoglobulin correlated with progression. A pooled statistical analysis of all of the patients confirmed the validity ofMayo Clinic riskmodel showing that IgAclass, serumMClevels, and light-chain proteinuria are the most important variables correlated with disease progression. Conclusions: Using simple variables, we validated a prognostic model for IgGMGUS. Among the IgA cases, the possible prognostic role of hemoglobin emerged in addition to a decrease in normal immunoglobulin levels.

Original languageEnglish
Pages (from-to)4439-4445
Number of pages7
JournalClinical Cancer Research
Volume15
Issue number13
DOIs
Publication statusPublished - 1 Jul 2009

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