title: New criteria to identify risk of progression in monoclonal gammopathy of uncertain significance and smoldering multiple myeloma based on multiparameter flow cytometry analysis of bone marrow plasma cells.
abstract: Monoclonal gammopathy of uncertain significance (MGUS) and smoldering multiple myeloma (SMM) are plasma cell disorders with a risk of progression of approximately 1% and 10% per year, respectively. We have previously shown that the proportion of bone marrow (BM) aberrant plasma cells (aPCs) within the BMPC compartment (aPC/BMPC) as assessed by flow cytometry (FC) contributes to differential diagnosis between MGUS and multiple myloma (MM). The goal of the present study was to investigate this parameter as a marker for risk of progression in MGUS (n = 407) and SMM (n = 93). Patients with a marked predominance of aPCs/BMPC (> or = 95%) at diagnosis displayed a significantly higher risk of progression both in MGUS and SMM (P< .001). Multivariate analysis for progression-free survival (PFS) selected the percentage aPC/BMPC (> or = 95%) as the most important independent variable, together with DNA aneuploidy and immunoparesis, for MGUS and SMM, respectively. Using these independent variables, we have identified 3 risk categories in MGUS (PFS at 5 years of 2%, 10%, and 46%, respectively; P< .001) and SMM patients (PFS at 5 years of 4%, 46%, and 72%, respectively; P < .001). Our results show that multiparameter FC evaluation of BMPC at diagnosis is a valuable tool that could help to individualize the follow-up strategy for MGUS and SMM patients.
authors.affiliation: Department of Hematology, University Hospital, Salamanca, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Pérez-Persona
authors.forename: María-Belén
authors.initials: MB
authors.lastname: Vidriales
authors.forename: Gema
authors.initials: G
authors.lastname: Mateo
authors.forename: Ramón
authors.initials: R
authors.lastname: García-Sanz
authors.forename: Maria-Victoria
authors.initials: MV
authors.lastname: Mateos
authors.forename: Alfonso García
authors.initials: AG
authors.lastname: de Coca
authors.forename: Josefina
authors.initials: J
authors.lastname: Galende
authors.forename: Guillermo
authors.initials: G
authors.lastname: Martín-Nuñez
authors.forename: José M
authors.initials: JM
authors.lastname: Alonso
authors.forename: Natalia
authors.initials: N
authors.lastname: de Las Heras
authors.forename: José M
authors.initials: JM
authors.lastname: Hernández
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martín
authors.forename: Consuelo
authors.initials: C
authors.lastname: López-Berges
authors.forename: Alberto
authors.initials: A
authors.lastname: Orfao
authors.forename: Jesús F
authors.initials: JF
authors.lastname: San Miguel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001854:Bone Marrow Cells / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000145:classification* / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D010265:Paraproteinemias / Q000145:classification* / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D010641:Phenotype; D010950:Plasma Cells / Q000473:pathology*; D012307:Risk Factors