title: Immunoparesis and monoclonal gammopathy of undetermined significance are disassociated in advanced age.
abstract: Immunoparesis and a skewed serum free light chain (FLC) ratio are indicators of immune dysfunction predictive of progression from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). Previous studies have reported increased prevalence of MGUS by age, but no study has examined the relationship between immunoparesis and abnormal FLC ratios in the elderly. We screened 453 older adults (median age, 80 years; range, 65-96) to characterize the patterns of immunoparesis and abnormal FLC ratio in relation to MGUS. We defined MGUS in 4.4% of the subjects; the prevalence was 12.5% among individuals of >90 years. In MGUS (vs. non-MGUS) cases, immunoparesis and abnormal FLC ratios were detected in 70.0% (vs. 49.0%; P = 0.07) and 50.0% (vs. 12.9%; P = 0.0001), respectively. Based on small numbers, MGUS patients with abnormal FLC ratio were borderline (P = 0.07) more likely to have immunoparesis. Overall, the prevalence of immunoparesis varied in a nonlinear fashion, with lowest frequencies in the youngest and oldest groups. Our observed disassociation between MGUS prevalence and impaired immunoglobulin production suggests that separate mechanisms are involved in the development of MGUS and immunoparesis in advanced age. These findings emphasize the need for molecularly defined methods to characterize myeloma precursor states and better predict progression to MM.
authors.affiliation: Multiple Myeloma Section, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Cherry
authors.forename: Rene
authors.initials: R
authors.lastname: Costello
authors.forename: Adriana
authors.initials: A
authors.lastname: Zingone
authors.forename: Jason
authors.initials: J
authors.lastname: Burris
authors.forename: Neha
authors.initials: N
authors.lastname: Korde
authors.forename: Elisabet
authors.initials: E
authors.lastname: Manasanch
authors.forename: Mary
authors.initials: M
authors.lastname: Kwok
authors.forename: Christina
authors.initials: C
authors.lastname: Annunziata
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Roschewski
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
authors.forename: Ola
authors.initials: O
authors.lastname: Landgren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D018450:Disease Progression; D004406:Dysgammaglobulinemia / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D016519:Hospitals, Religious; D006786:Hospitals, Urban; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000032:analysis; D008297:Male; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D009101:Multiple Myeloma / Q000209:etiology; D009519:New York City / Q000453:epidemiology; D015995:Prevalence
chemical_list: D007147:Immunoglobulin Light Chains