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Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance | 意义未明单克隆免疫球蛋白血症的长期随访
The New England Journal of Medicine ( IF 158.5 ) Pub Date : 2018-01-18 19:50:00 , DOI: 10.1056/nejmoa1709974
Robert A. Kyle 1 , Dirk R. Larson 1 , Terry M. Therneau 1 , Angela Dispenzieri 1 , Shaji Kumar 1 , James R. Cerhan 1 , S. Vincent Rajkumar 1
Affiliation  

结论


IgM意义未明单克隆免疫球蛋白血症(MGUS)患者和非IgM MGUS患者之间的疾病进展风险有显著差异。MGUS患者的总生存期比匹配对照人群中预期的要短。

Background

Monoclonal gammopathy of undetermined significance (MGUS) occurs in approximately 3% of persons 50 years of age or older.



Methods

We studied 1384 patients who were residing in southeastern Minnesota and in whom MGUS was diagnosed at the Mayo Clinic in the period from 1960 through 1994; the median follow-up was 34.1 years (range, 0.0 to 43.6). The primary end point was progression to multiple myeloma or another plasma-cell or lymphoid disorder.



Results

During 14,130 person-years of follow-up, MGUS progressed in 147 patients (11%), a rate that was 6.5 times (95% confidence interval [CI], 5.5 to 7.7) as high as the rate in the control population. The risk of progression without accounting for death due to competing causes was 10% at 10 years, 18% at 20 years, 28% at 30 years, 36% at 35 years, and 36% at 40 years. Among patients with IgM MGUS, the presence of two adverse risk factors — namely, an abnormal serum free light-chain ratio (ratio of kappa to lambda free light chains) and a high serum monoclonal protein (M protein) level (≥1.5 g per deciliter) — was associated with a risk of progression at 20 years of 55%, as compared with 41% among patients who had one adverse risk factor and 19% among patients who had neither risk factor. Among patients with non-IgM MGUS, the risk of progression at 20 years was 30% among those who had the two risk factors, 20% among those who had one risk factor, and 7% among those who had neither risk factor. Patients with MGUS had shorter survival than was expected in the control population of Minnesota residents of matched age and sex (median, 8.1 vs. 12.4 years; P<0.001).



Conclusions

Significant differences were noted in the risk of progression between patients with IgM MGUS and those with non-IgM MGUS. Overall survival was shorter among patients with MGUS than was expected in a matched control population. (Funded by the National Cancer Institute.)




Supported in part by research grants (CA107476, CA168762, and CA186781) from the National Cancer Institute.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.


Source Information

From the Divisions of Hematology (R.A.K., A.D., S.K., S.V.R.), Biostatistics (D.R.L., T.M.T.), and Epidemiology (J.R.C.), Mayo Clinic, Rochester, MN.

Address reprint requests to Dr. Kyle at the Division of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, or at kyle.robert@mayo.edu.




中文翻译:

意义未定的单克隆丙种球蛋白病的长期随访 意义未明引发免疫球蛋白血症的长期随访

摘要


IgM意义未明的急性免疫球蛋白血症(MGUS)患者和非IgM MGUS患者之间的疾病进展风险有显着的差异。

背景

意义不明的单克隆丙种球蛋白病(MGUS)发生在50岁以上的人群中,约占3%。



方法

我们研究了1384例居住在明尼苏达州东南部的患者,这些患者在1960年至1994年期间被梅奥诊所确诊为MGUS。中位随访时间为34.1年(范围为0.0至43.6)。主要终点是进展为多发性骨髓瘤或另一种浆细胞或淋巴样疾病。



结果

在14,130人年的随访期间,MGUS进展为147例患者(11%),是对照组的6.5倍(95%置信区间[CI]为5.5至7.7)。不考虑竞争原因导致死亡的进展风险为:10年时为10%,20年时为18%,30年时为28%,35年时为36%,40年时为36%。在患有IgM MGUS的患者中,存在两个不利的危险因素-异常的血清游离轻链比率(κ与λ游离轻链之比)和较高的血清单克隆蛋白(M蛋白)水平(≥1.5 g / g分升)-与20岁时的进展风险相关为55%,而具有一种不良危险因素的患者为41%,而没有危险因素的患者为19%。在非IgM MGUS患者中,具有两种危险因素的人在20岁时发展的风险为30%,具有一种危险因素的人为20%,而没有危险因素的人为7%。MGUS患者的生存期短于明尼苏达州年龄和性别相匹配的对照人群的预期寿命(中位值分别为8.1岁和12.4岁; P <0.001)。



结论

IgM MGUS患者与非IgM MGUS患者之间的进展风险存在显着差异。MGUS患者的总生存期短于匹配对照组的预期寿命。(由国家癌症研究所资助。)




国家癌症研究所的研究资助(CA107476,CA168762和CA186781)部分得到支持。

作者提供的披露表可在NEJM.org上获得本文的全文。


源信息

来自明尼苏达州罗切斯特市梅奥诊所的血液学部门(RAK,AD,SK,SVR),生物统计学(DRL,TMT)和流行病学(JRC)。

将转载请求发送至MN 55905,罗切斯特市梅斯特诊所,梅奥诊所,梅奥诊所,血液科,邮编55905,或发送电子邮件至kyle.robert@mayo.edu。


更新日期:2018-01-22
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