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New Prevalence Data on Monoclonal Gammopathies
The prevalence of monoclonal gammopathy of undetermined significance (MGUS) has been examined largely in white populations of European descent. In this study, researchers examined the prevalence of MGUS in potentially higher-risk populations using mass spectrometry, a highly sensitive detection technique.
The study population of 7600 people was drawn from a U.S. screening study (PROMISE) and the Mass General Brigham Biobank; one third of participants self-identified as Black, and about half had family histories of hematologic malignancy. Most participants were between ages 30 and 70. Findings were classified as MGUS (serum monoclonal protein concentration, ≥0.2 g/L) or MGIP (monoclonal gammopathy of indeterminate potential; concentration, 0.015–0.2 g/L).
Findings were as follows:
- The prevalence of any monoclonal gammopathy, detected by mass spectrometry, increased with age.
- Among people older than 50, the prevalence of MGUS was 17% in Black people, 13% among non-Black people with family histories of hematologic malignancy, and 10% among those without either high-risk feature. In contrast, the prevalence of MGIP was about 30% in all three risk groups.
- Most MGUS cases were IgG, whereas most MGIP cases were IgM.
- During median follow-up of 5 years, MGUS was associated with development of lymphoid hematologic malignancy, but MGIP was not.
Comment — General Medicine With sensitive detection methods, monoclonal gammopathies are more common than previously reported; certain risk groups have somewhat higher-than-average prevalence. Cases classified here as MGIP are below the detection threshold for conventional serum protein electrophoresis with immunofixation, which is used by most laboratories. The authors propose that some of the monoclonal proteins in this newly characterized MGIP category are transient (i.e., associated with inflammation), whereas others might be early precursors to eventual MGUS or hematologic malignancy.
Comment — Oncology and Hematology These findings of MGIP prevalence considerably increase the population at risk for evolution to plasma cell dyscrasias (e.g., MGUS, myeloma, amyloidosis) and other lymphoproliferative disorders. In addition, even a very low–concentration paraprotein can mediate peripheral neuropathy and nephropathies, such as proliferative glomerulonephritis with monoclonal IgG deposits, wherein the paraprotein might be undetectable by current assays. Additional analyses of MGUS and MGIP thus will be of great interest in other at-risk populations and disease settings.
El-Khoury H et al.
Title: Prevalence of monoclonal gammopathies and clinical outcomes in a high-risk US population screened by mass spectrometry: A multicentre cohort study.
Source: Lancet Haematol 2022 May ; [e-pub]. (Abstract/FREE Full Text)