title: Immunoglobulin M monoclonal gammopathies of undetermined significance and indolent Waldenstrom's macroglobulinemia recognize the same determinants of evolution into symptomatic lymphoid disorders: proposal for a common prognostic scoring system.
abstract: OBJECTIVE
  To evaluate the clinicohematologic variables at diagnosis that are prognostically related to neoplastic progression in patients with immunoglobulin M (IgM) monoclonal gammopathies of undetermined significance (MGUS), and indolent Waldenström's macroglobulinemia (IWM), and propose a scoring system to identify subsets of patients at different risk.
  
  
  METHODS
  We evaluated 217 patients with IgM MGUS and 201 with IWM (male-female ratio, 131:86 and 117:84; mean age, 63.7 and 63.6 years, respectively) diagnosed on the basis of serum monoclonal component (MC) levels and bone marrow lymphoplasmacytic infiltration degree. The variables selected by univariate analyses were multivariately investigated; on the basis of their individual relative hazards, a scoring system was devised to identify subsets of patients at different risk of evolution.
  
  
  RESULTS
  After a median follow-up of 56.1 and 60.2 months, 15 of 217 MGUS and 45 of 201 IWM patients, respectively, required chemotherapy for symptomatic WM (13 and 36), non-Hodgkin's lymphoma (2 and 6) and amyloidosis (0 and 3). The median time to evolution (TTE) was not reached for MGUS and was 141.5 months for IWM. The variables adversely related to evolution were qualitatively the same in both groups: MC levels, Hb concentrations and sex. A scoring system based on these parameters identified three risk groups with highly significant differences in TTE in both groups (P < .0001).
  
  
  CONCLUSIONS
  MGUS and IWM identify disease entities with different propensities for symptomatic neoplastic evolution. As both have the same prognostic determinants of progression, we propose a practical scoring system that, identifying different risks of malignant evolution, may allow an individualized clinical approach.
authors: Unità Operativa Ematologia 1, Dipartimento di Ematologia e Oncologia, Ospedale Maggiore, I.R.C.C.S, Milano, Italy. lubaldini@policlinico.mi.it
authors: Luca
authors: L
authors: Baldini
authors: Maria
authors: M
authors: Goldaniga
authors: Andrea
authors: A
authors: Guffanti
authors: Chiara
authors: C
authors: Broglia
authors: Sergio
authors: S
authors: Cortelazzo
authors: Andrea
authors: A
authors: Rossi
authors: Enrica
authors: E
authors: Morra
authors: Mariangela
authors: M
authors: Colombi
authors: Vincenzo
authors: V
authors: Callea
authors: Enrico
authors: E
authors: Pogliani
authors: Fiorella
authors: F
authors: Ilariucci
authors: Stefano
authors: S
authors: Luminari
authors: Pierre
authors: P
authors: Morel
authors: Giampaolo
authors: G
authors: Merlini
authors: Paolo
authors: P
authors: Gobbi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000145:classification* / Q000401:mortality; D015996:Survival Rate; D008258:Waldenstrom Macroglobulinemia / Q000145:classification* / Q000401:mortality
chemical_list: D007075:Immunoglobulin M