I understand that 1% of patients diagnosed with MGUS will progress to multiple myeloma. My question is does the 1% progress greater each year, in other words become 10% after having MGUS for 10 years or, as in my case, become 30% after being diagnosed with MGUS after donating platelets in 1984?
Thank you , Ann
Forums
8 posts
• Page 1 of 1
Re: Percent of MGUS patients progressing to multiple myeloma
Hello, the generalization is that the risk of progression is 1% per year for MGUS patients developing active multiple myeloma. So, after 20 years, the risk of progression is 20%, and 30% after 30 years.
However, the Mayo Clinic has also found that the risk of progression also correlates with M-spike levels detected at diagnosis. The higher the M-spike at diagnosis, the higher the risk of progression. Here's a summary of the factors found by Mayo to affect risk of progression from MGUS to multiple myeloma:
1. Non-IgG isotype
2. Serum M protein greater than 1.5 g/dL
3. Kappa/lambda or lambda/kappa ratio being skewed, or out of normal range.
For patients with 0 of these major risk factors, the risk of progression at 20 years is 5%.
For patients with 1, the risk factor is 21%.
For those having 2 of these conditions, it's 37%
And for those meeting all three of those criteria, it's 58%.
There are more discussions as well in these reviews
Korde et al, "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies,", Blood, May 26, 2011, 117 (21)
Agarwal et al, "Monoclonal gammopathy of undetermined significance and Smoldering Multiple Myeloma: A review of the current understanding of epidemiology, biology, risk stratification and management of myeloma precursor disease," Clinical Cancer Research, March 1, 2013 19; 985.
However, the Mayo Clinic has also found that the risk of progression also correlates with M-spike levels detected at diagnosis. The higher the M-spike at diagnosis, the higher the risk of progression. Here's a summary of the factors found by Mayo to affect risk of progression from MGUS to multiple myeloma:
1. Non-IgG isotype
2. Serum M protein greater than 1.5 g/dL
3. Kappa/lambda or lambda/kappa ratio being skewed, or out of normal range.
For patients with 0 of these major risk factors, the risk of progression at 20 years is 5%.
For patients with 1, the risk factor is 21%.
For those having 2 of these conditions, it's 37%
And for those meeting all three of those criteria, it's 58%.
There are more discussions as well in these reviews
Korde et al, "Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies,", Blood, May 26, 2011, 117 (21)
Agarwal et al, "Monoclonal gammopathy of undetermined significance and Smoldering Multiple Myeloma: A review of the current understanding of epidemiology, biology, risk stratification and management of myeloma precursor disease," Clinical Cancer Research, March 1, 2013 19; 985.
-
dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Percent of MGUS patients progressing to multiple myeloma
Ann,
To be clear, it's not like your chances of progressing from MGUS after 30 years have now increased to 30% at this instant in time. Instead, this data is saying that the chance that one might progress to MGUS over a 30 year period is 30% (this is known as the cumulative incidence rate). But your risk of progression in any given year is still 1%.
Note that you would adjust the percentages above accordingly based on how many of the Mayo risk factors you actually have.
To be clear, it's not like your chances of progressing from MGUS after 30 years have now increased to 30% at this instant in time. Instead, this data is saying that the chance that one might progress to MGUS over a 30 year period is 30% (this is known as the cumulative incidence rate). But your risk of progression in any given year is still 1%.
Note that you would adjust the percentages above accordingly based on how many of the Mayo risk factors you actually have.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Percent of MGUS patients progressing to multiple myeloma
Multibilly - Hi, I wonder what your thoughts are regarding my risks.
My initial M spike was 1.0 in Oct 2011 and about two months later it was 1.5. Since then, the spikes have been 1.1. 1.0, 1.0, .9, and now 0.8 (all at same lab - LabCorp).
No CRAB, trisomic 7, 5% aspirate, and Ig MGUS.
For 10-11 years, my WBC is typically below or at 4, does that matter? And, the IgM is lower than normal.
Appreciate your thoughts,
Diane
My initial M spike was 1.0 in Oct 2011 and about two months later it was 1.5. Since then, the spikes have been 1.1. 1.0, 1.0, .9, and now 0.8 (all at same lab - LabCorp).
No CRAB, trisomic 7, 5% aspirate, and Ig MGUS.
For 10-11 years, my WBC is typically below or at 4, does that matter? And, the IgM is lower than normal.
Appreciate your thoughts,
Diane
-
Dianem
Re: Percent of MGUS patients progressing to multiple myeloma
Diane,
You can figure this out pretty easily yourself. Just go back an look at the 3-factor Mayo model that Alex talked about above.
You just need to know if your M-Spike was > 1.5 g/dL, if you are non-IgG MGUS and if your FLC Ratio is (< 0.26 or > 1.65).
You can figure this out pretty easily yourself. Just go back an look at the 3-factor Mayo model that Alex talked about above.
You just need to know if your M-Spike was > 1.5 g/dL, if you are non-IgG MGUS and if your FLC Ratio is (< 0.26 or > 1.65).
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Percent of MGUS patients progressing to multiple myeloma
Thanks Multibilly.
Yes, I understand the Mayo guidelines. Tthey did all my initial testing here in AZ. Some articles have stated an abnormal low of an unaffected immunoglobulin (IgM) and low WBC are also risk factors, but I can't find guidelines for progression with these variables.
Thanks, have a good weekend.
Yes, I understand the Mayo guidelines. Tthey did all my initial testing here in AZ. Some articles have stated an abnormal low of an unaffected immunoglobulin (IgM) and low WBC are also risk factors, but I can't find guidelines for progression with these variables.
Thanks, have a good weekend.
-
Dianem
Re: Percent of MGUS patients progressing to multiple myeloma
I was diagnosed in 2014, latest labs changed a little. I am a 60 year old male. I am curious as to what type of MGUS I have, and am confused by the Mayo Clinic criteria for the risk of progression based on three factors
August 27, 2014 results:
CBC
wbc 4.4
rbc 4.14
hgb 13.8
hematocrit 41.5%
mcv 100
rdw, rbc 12.6
platelets 191
calcium 9.4
creatinine 0.93.
spe results
total protein 6.5
alpha 1 glob/prot 4.1%
alpha 2 glob/prot missing from my results page
beta glob/prot 12.1
gamma glob/prot 10.3 low
m-band percentage #1 less than 5.0
kappa, lambda light chains free w/ratio, serum
kappa 8.48,
lambda 18.70,
kappa/lambda free ratio 0.45
Serum immunoelectrophoresis
ig/g 684
ig/a 363
ig/m 26 low.
August 7, 2016 results
wbc 4.0
rbc 4.03
hgb 13.2
hematocrit 40.9
mcv 102
rdw, rbc 12.9
platelets 177
calcium 9.5
creatinine 0.94.
spe results
total protein 6.5
alpha 1 glob/prot 3.9%
alpha 2 glob/prot 10.3%
beta glob/prot 11.8%
gamma glob/prot 9.8 % low
m-band percentage #1 less than 5.0.
The other tests were not repeated this year. I am scheduled for a cbc in six months.
I am interested in where I stand relative to the Mayo Clinic three factors, and if these new results are a cause for concern. My GP, who I like a lot, thinks they are not.
Thank you!
August 27, 2014 results:
CBC
wbc 4.4
rbc 4.14
hgb 13.8
hematocrit 41.5%
mcv 100
rdw, rbc 12.6
platelets 191
calcium 9.4
creatinine 0.93.
spe results
total protein 6.5
alpha 1 glob/prot 4.1%
alpha 2 glob/prot missing from my results page
beta glob/prot 12.1
gamma glob/prot 10.3 low
m-band percentage #1 less than 5.0
kappa, lambda light chains free w/ratio, serum
kappa 8.48,
lambda 18.70,
kappa/lambda free ratio 0.45
Serum immunoelectrophoresis
ig/g 684
ig/a 363
ig/m 26 low.
August 7, 2016 results
wbc 4.0
rbc 4.03
hgb 13.2
hematocrit 40.9
mcv 102
rdw, rbc 12.9
platelets 177
calcium 9.5
creatinine 0.94.
spe results
total protein 6.5
alpha 1 glob/prot 3.9%
alpha 2 glob/prot 10.3%
beta glob/prot 11.8%
gamma glob/prot 9.8 % low
m-band percentage #1 less than 5.0.
The other tests were not repeated this year. I am scheduled for a cbc in six months.
I am interested in where I stand relative to the Mayo Clinic three factors, and if these new results are a cause for concern. My GP, who I like a lot, thinks they are not.
Thank you!
Re: Percent of MGUS patients progressing to multiple myeloma
Radio16,
You need to go back and see what your serum immunofixation results were. That test will tell you your isotype (IgG, IgA or IgM). It's tough to tell your isotype without that test since your IgA and IgG don't seem to be reading out of bounds because you have a pretty small M-spike. But I'm guessing you may have an IgA lambda isotype since your IgA immuonglobulin level tends towards the high end of the normal range and your lambda free light chain is also towards the upper end of normal.
Your serum protein electrophoresis (SPE, SPEP) results should also have absolute numbers for your M-band (aka M-spike). But your M-band % it is less than 5% of 6.5 g/dL, so that would make your M-spike less than 1.5 g/dL.
Your free light chain numbers appear to be in range.
So, you may have one Mayo risk factor if your immunofixation shows an IgA isotype.
I also note that your IgM is low. This is a condition known as immunoparesis and has been associated with a higher risk of progression in MGUS patients in at least one earlier study:
Turesson, I., et al, "Monoclonal gammopathy of undetermined significance and risk of lymphoid and myeloid malignancies: 728 cases followed up to 30 years in Sweden," Blood, 2014 (full text of article)
Note that it's always really helpful if you include the units of measure and normal reference ranges when posting any lab values.
Hope this helps.
You need to go back and see what your serum immunofixation results were. That test will tell you your isotype (IgG, IgA or IgM). It's tough to tell your isotype without that test since your IgA and IgG don't seem to be reading out of bounds because you have a pretty small M-spike. But I'm guessing you may have an IgA lambda isotype since your IgA immuonglobulin level tends towards the high end of the normal range and your lambda free light chain is also towards the upper end of normal.
Your serum protein electrophoresis (SPE, SPEP) results should also have absolute numbers for your M-band (aka M-spike). But your M-band % it is less than 5% of 6.5 g/dL, so that would make your M-spike less than 1.5 g/dL.
Your free light chain numbers appear to be in range.
So, you may have one Mayo risk factor if your immunofixation shows an IgA isotype.
I also note that your IgM is low. This is a condition known as immunoparesis and has been associated with a higher risk of progression in MGUS patients in at least one earlier study:
Turesson, I., et al, "Monoclonal gammopathy of undetermined significance and risk of lymphoid and myeloid malignancies: 728 cases followed up to 30 years in Sweden," Blood, 2014 (full text of article)
Note that it's always really helpful if you include the units of measure and normal reference ranges when posting any lab values.
Hope this helps.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
8 posts
• Page 1 of 1