title: Bence Jones proteinuria in smoldering multiple myeloma as a predictor marker of progression to symptomatic multiple myeloma.
abstract: The diagnosis of smoldering multiple myeloma (SMM) includes patients with a heterogeneous risk of progression to active multiple myeloma (MM): some patients will never progress, whereas others will have a high risk of progression within the first 2 years. Therefore, it is important to improve risk assessment at diagnosis. We conducted a retrospective study in a large cohort of SMM patients, in order to investigate the role of Bence Jones (BJ) proteinuria at diagnosis in the progression to active MM. We found that SMM patients presenting with BJ proteinuria had a significantly shorter median time to progression (TTP) to MM compared with patients without BJ proteinuria (22 vs 88 months, respectively; hazard ratio=2.3, 95% confidence interval=1.4-3.9, P=0.002). We also identified risk subgroups based on the amount of BJ proteinuria: ⩾500 mg/24 h, <500 mg/24 h and without it, with a significantly different median TTP (13, 37 and 88 months, P<0.001). Thus, BJ proteinuria at diagnosis is an independent variable of progression to MM that identifies a subgroup of high-risk SMM patients (51% risk of progression at 2 years) and ⩾500 mg of BJ proteinuria may allow, if validated in another series, to reclassify these patients to MM requiring therapy before the end-organ damage development.
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: V
authors.initials: V
authors.lastname: González-Calle
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Dávila
authors.affiliation: Complejo Asistencial Universitario de León, León, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Escalante
authors.affiliation: Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: A G
authors.initials: AG
authors.lastname: de Coca
authors.affiliation: Hospital del Bierzo, Ponferrada, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Aguilera
authors.affiliation: Hospital Virgen Del Puerto, Plasencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: López
authors.affiliation: Hospital Nuestra Señora de Sonsoles, Ávila, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Bárez
authors.affiliation: Complejo Asistencial Universitario de Palencia, Palencia, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Alonso
authors.affiliation: Complejo Asistencial de Zamora, Zamora, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Hernández
authors.affiliation: Complejo Asistencial de Segovia, Segovia, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Hernández
authors.affiliation: Complejo Asistencial Universitario de Burgos, Burgos, Spain.
authors.forename: P
authors.initials: P
authors.lastname: de la Fuente
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Puig
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: Ocio
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: N C
authors.initials: NC
authors.lastname: Gutiérrez
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: R
authors.initials: R
authors.lastname: García-Sanz
authors.affiliation: Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
authors.forename: M V
authors.initials: MV
authors.lastname: Mateos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001536:Bence Jones Protein / Q000652:urine*; D014408:Biomarkers, Tumor / Q000652:urine; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000652:urine; D011507:Proteinuria; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; D001536:Bence Jones Protein