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.
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.
Pérez-Persona
Ernesto
E
Department of Hematology, University Hospital, Salamanca, Spain.
Vidriales
María-Belén
MB
Mateo
Gema
G
García-Sanz
Ramón
R
Mateos
Maria-Victoria
MV
de Coca
Alfonso García
AG
Galende
Josefina
J
Martín-Nuñez
Guillermo
G
Alonso
José M
JM
de Las Heras
Natalia
N
Hernández
José M
JM
Martín
Alejandro
A
López-Berges
Consuelo
C
Orfao
Alberto
A
San Miguel
Jesús F
JF
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