Page 1752 - Williams Hematology ( PDFDrive )

1726 Part XI: Malignant Lymphoid Diseases Chapter 106: Essential Monoclonal Gammopathy 1727

more than 25 years after the diagnosis of monoclonal gammopathy. The 3. Hallen J: Frequency of “abnormal serum globulins” (M-components) in the aged. Acta
actuarial risk of progressing to a clonal B-cell malignancy for all classes Med Scand 173:737, 1963.
of monoclonal protein is approximately 0.5 to 1.0 percent per year 4. Axelsson U, Bachmann R, Hallen J: Frequency of pathological proteins (M-compo-
nents) in 6995 sera from an adult population. Acta Med Scand 179:235, 1966.
depending on the population studied. 12,224–226 IgM gammopathy usually 5. Migliore PJ, Alexanian R: Monoclonal gammopathy in human neoplasia. Cancer
progresses to lymphoma, macroglobulinemia, amyloidosis, or chronic 21:1127, 1968.
lymphocytic leukemia. Although one large study found that IgM 6. Ritzmann SE, Loukes D, Sakai H, et al: Idiopathic (asymptomatic) monoclonal gam-
227
mopathies. Arch Intern Med 135:95, 1975.
monoclonal gammopathy evolved to a progressive clonal lymphoid dis- 7. Amies A, Ko HS, Pruzanski W: M-components: A review of 1242 cases. Can Med Assoc
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order at a rate of approximately 1.5 percent per year, two other large J 114:889, 1976.
studies found no significant difference in the rate of progression when 8. Lindstrom FD, Dahlstrom V: Multiple myeloma or benign monoclonal gammopathy?
patients with IgG or IgM were compared. 229,230 IgG or IgA monoclonal A study of differential diagnostic criteria in 44 cases. Clin Immunol Immunopathol
10:168, 1978.
gammopathy evolves principally into myeloma, plasmacytoma, or amy- 9. Salerin JP, Vicariot M, Deroff P, et al: Monoclonal gammopathies in the adult popula-
loidosis. 231,232 Several studies have found a somewhat higher progression tion of Finistère, France. J Clin Pathol 35:63, 1982.
rate in persons with IgA monoclonal gammopathy. 18,233 10. Kyle RA: Monoclonal gammopathy of undetermined significance and solitary mye-
loma. Hematol Oncol Clin North Am 11:71, 1997.
Patients with a higher percentage of plasma cells in the marrow, 11. Owen RG, Parapia LA, Higginson J, et al: Clinicopathological correlates of IgM para-
higher monoclonal Ig levels at the time of diagnosis, lower levels of proteinemias. Clin Lymphoma 1:39, 2000.
polyclonal Ig, an elevated erythrocyte sedimentation rate, a more dis- 12. Turesson I, Kovalchik SA, Pfeiffer RM, et al: Monoclonal gammopathy of undeter-
mined significance and risk of lymphoid and myeloid malignancies: 728 cases followed
turbed serum light chain ratio, a lower relative proportion of CD19+ up to 30 years in Sweden. Blood 123:338, 2014.
plasma cells, and more than one focal lesion in marrow as determined 13. Lichtman MA. Monoclonal gammopathy: Do we know its significance? Blood Cells Mol
by whole-body magnetic resonance imaging evolve to a progressive Dis 45:267, 2010.
clonal B-lymphocyte disease more frequently. 12,229–236 None of these 14. Ligthart GL, Radl J, Corberand JX, et al: Monoclonal gammopathies in human aging:
Increased occurrence with age and correlation with health status. Mech Ageing Dev
variables have the specificity and sensitivity to be highly accurate in 52:235, 1990.
predicting the behavior of an individual patient. Neither the plasma cell 15. Kyle RA, Rajkumar SV: Epidemiology of the plasma-cell disorders. Best Pract Res Clin
Haematol 20:637, 2007.
gene-expression profile nor the cell population cytogenetic findings are 16. Sinclair D, Sheehan T, Parrott DMV, Stott DI: The incidence of monoclonal gammopa-
sufficiently specific to predict progression from a stable to an unstable thy in a population over 45 years old determined by isoelectric focusing. Br J Haematol
clone based on current studies. 41,237 These findings indicate, not surpris- 67:745, 1986.
ingly, that the qualitative leap is between normal, polyclonal plasma cells 17. Radl J, Wels J, Hoogeven CM: Immunoblotting with (sub)class specific antibodies
(B lymphocytes) and the emergence of a monoclonal population (either reveals a high frequency of monoclonal antibodies in persons thought to be immuno-
deficient. Clin Chem 34:1839, 1988.
stable or progressively growing) and that the distinctions between the 18. Ögmundsdóttir HM, Haraldsdóttir V, M Jóhannesson G, et al: Monoclonal gammo-
latter two states are subtle, complex, and as yet unidentified. In rare pathy in Iceland: A population-based registry and follow-up. Br J Haematol 118:166,
2002.
patients, the monoclonal protein appears transiently in relation to a dis- 19. Ong F, Hermans J, Noordik EM, et al: A population-based registry on paraproteinaemia
ease (e.g., infection) 202,204,205 or disappears spontaneously even when not in the Netherlands. Br J Haematol 99:914, 1997.
associated with a disease (clonal exhaustion). 3 20. Iwanaga M, Tagawa M, Tsukasaki K, et al: Prevalence of monoclonal gammopathy of
Generally, the diagnosis of essential monoclonal gammopathy can- undetermined significance: Study of 52,802 persons in Nagasaki City, Japan. Mayo Clin
Proc 82:1474, 2007.
not be made with certainty at the time of the initial evaluation. Periodic 21. Iwanaga M, Tomonaga M. Prevalence of monoclonal gammopathy of undetermined
reexamination is required to document a stable clinical course. One of significance in Asia: A viewpoint from Nagasaki atomic bomb survivors. Clin Lym-
the most subtle interfaces is between essential monoclonal gammopathy phoma Myeloma Leuk 14:18, 2014.
and smoldering myeloma (Chap. 107). In the latter, the marrow plasma 22. Wu SP, Minter A, Costello R, et al: MGUS prevalence in an ethnically Chinese popula-
tion in Hong Kong. Blood 121:2363, 2013.
cell concentration is between 10 and 20 percent or the monoclonal pro- 23. Landgren O, Katzmann JA, Hsing AW, et al: Prevalence of monoclonal gammopathy of
tein concentration is greater than 3 g/dL or both. There is no anemia, undetermined significance among men in Ghana. Mayo Clin Proc 82:1468, 2007.
increase in serum calcium, or evident bone or kidney disease. Careful 24. Schecter GP, Shoff N, Chan C, et al: The frequency of monoclonal gammopathy in black
238
and white veterans in a hospital population, in Epidemiology and Biology of Multiple
observation of patients with presumed essential monoclonal gammo- Myeloma, edited by Obrams GI, Potter M, p 93. Springer-Verlag, New York, 1991.
pathy should permit identification of those who are better categorized 25. Singh J, Dudley AW, Kulig KA: Increased incidence of monoclonal gammopathy of
as smoldering myeloma. Although at this time treatment is not recom- undetermined significance in blacks and its age-related differences with whites on
mended for smoldering myeloma until progression, calls for clinical tri- the basis of a study of 397 men and one woman in a hospital setting. J Lab Clin Med
116:785, 1990.
als to assess whether early treatment may improve outcome have been 26. Landgren O, Gridley G, Turesson I, et al: Risk of monoclonal gammopathy of undeter-
made. Therapy is not required for essential monoclonal gammopathy mined significance (MGUS) and subsequent multiple myeloma among African Ameri-
239
can and white veterans in the United States. Blood 107:904, 2006.
without a confirmed diagnosis of myeloma, macroglobulinemia, amy- 27. Landgren O, Graubard BI, Katzmann JA, et al: Racial disparities in the prevalence of
loidosis, or lymphoma with evidence of progressive disease. Therapy monoclonal gammopathies: A population-based study of 12 482 persons from the
may be indicated, however, if the monoclonal protein interferes with the National Health and Nutritional Examination Survey. Leukemia 28:1537, 2014.
vital function of a normal plasma or tissue constituent, induces kidney 28. Bizzaro N, Pasini P: Familial occurrence of multiple myeloma and monoclonal gammo-
pathy of undetermined significance in siblings. Haematologica 75:58, 1990.
disease, or is associated with a disabling neuropathy. 29. Lynch HT, Sanger WG, Pirruccello S, et al: Familial multiple myeloma: A family study
A better understanding and an ability to identify the somatic and review of the literature. J Natl Cancer Inst 94:1479, 2001.
mutations that underlie the evolution of monoclonal gammopathy to a 30. Ögmundsdóttir HM, Haraldsdóttirm V, Jóhannesson GM, et al: Familiality of benign
progressive and potentially fatal B-cell neoplasm may permit the appli- and malignant paraproteinemias. A population-based cancer-registry study of multiple
myeloma families. Haematologica 90:66, 2005.
cation of therapy at an earlier time when curability or sustained remis- 31. Ögmundsdóttir HM, Valgeirsdóttir S, Schiffhauer HR, et al: Familial predisposition
sions would be more frequent. 240–242 to monoclonal gammopathies: Deviations in B-cell biology. Clin Lymphoma Myeloma
Leuk 13:191, 2013.
32. Pasqualetti P, Collacciani A, Casole R: Risk of monoclonal gammopathy of undeter-
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