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      MGUS Predicts Worse Prognosis in Patients with Coronary Artery Disease

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          Abstract

          We performed a retrospective cohort study to analyze all 87 CAD patients with MGUS and 178 CAD patients without MGUS admitted in Zhongshan Hospital Fudan University from 2015 to 2017. Patients were followed up via regular patient visits or telephone, and the median follow-up period was 2.9 years. The end point of follow-up was the occurrence of major adverse cardiac events (MACE). CAD patients with MGUS had a higher risk of MACE than those without MGUS (log-rank P = 0.0015). After adjustment for other markers in the stepwise Cox regression model, MGUS was still related to the increasing risk of MACE incident ( P = 0.002, HR = 2.308). Then, we constructed the nomogram based on the Cox regression model, and the concordance index (C-index) was 0.667. Hence, MGUS might be added into the risk model of CAD.

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          The online version of this article (10.1007/s12265-019-09950-w) contains supplementary material, which is available to authorized users.

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          Prevalence of monoclonal gammopathy of undetermined significance.

          Robert A Kyle, Terry Therneau, S Vincent Rajkumar … (2006)
          The prevalence of monoclonal gammopathy of undetermined significance (MGUS), a premalignant plasma-cell disorder, among persons 50 years of age or older has not been accurately determined. We used sensitive laboratory techniques to ascertain the prevalence of MGUS in a large population in a well-defined geographic area. We identified all living residents of Olmsted County, Minnesota, as of January 1, 1995. We obtained serum that remained after the performance of routine clinical tests at Mayo Clinic or asked subjects for whom such serum was unavailable to provide a sample. Agarose-gel electrophoresis was performed on all serum samples, and any serum sample with a discrete band of monoclonal protein or thought to have a localized band was subjected to immunofixation. Serum samples were obtained from 21,463 of the 28,038 enumerated residents 50 years of age or older (76.6 percent). MGUS was identified in 694 (3.2 percent) of these persons. Age-adjusted rates were higher in men than in women (4.0 percent vs. 2.7 percent, P<0.001). The prevalence of MGUS was 5.3 percent among persons 70 years of age or older and 7.5 percent among those 85 years of age or older. The concentration of monoclonal immunoglobulin was less than 1.0 g per deciliter in 63.5 percent and at least 2.0 g per deciliter in only 4.5 percent of 694 persons. The concentration of uninvolved immunoglobulins was reduced in 27.7 percent of 447 persons tested, and 21.5 percent of 79 tested had a monoclonal urinary light chain. Among residents of Olmsted County, Minnesota, MGUS was found in 3.2 percent of persons 50 years of age or older and 5.3 percent of persons 70 years of age or older. Copyright 2006 Massachusetts Medical Society.
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            Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance

            Robert A Kyle, Dirk R. Larson, Terry Therneau … (2018)
            BACKGROUND Monoclonal gammopathy of undetermined significance (MGUS) occurs in approximately 3% of persons 50 years of age or older. METHODS We studied 1384 patients who were residing in southeastern Minnesota and in whom MGUS was diagnosed at the Mayo Clinic in the period from 1960 through 1994; the median follow-up was 34.1 years (range, 0.0 to 43.6). The primary end point was progression to multiple myeloma or another plasma-cell or lymphoid disorder. RESULTS During 14,130 person-years of follow-up, MGUS progressed in 147 patients (11%), a rate that was 6.5 times (95% confidence interval [CI], 5.5 to 7.7) as high as the rate in the control population. The risk of progression without accounting for death due to competing causes was 10% at 10 years, 18% at 20 years, 28% at 30 years, 36% at 35 years, and 36% at 40 years. Among patients with IgM MGUS, the presence of two adverse risk factors — namely, an abnormal serum free light-chain ratio (ratio of kappa to lambda free light chains) and a high serum monoclonal protein (M protein) level (≥1.5 g per deciliter) — was associated with a risk of progression at 20 years of 55%, as compared with 41% among patients who had one adverse risk factor and 19% among patients who had neither risk factor. Among patients with non-IgM MGUS, the risk of progression at 20 years was 30% among those who had the two risk factors, 20% among those who had one risk factor, and 7% among those who had neither risk factor. Patients with MGUS had shorter survival than was expected in the control population of Minnesota residents of matched age and sex (median, 8.1 vs. 12.4 years; P<0.001). CONCLUSIONS Significant differences were noted in the risk of progression between patients with IgM MGUS and those with non-IgM MGUS. Overall survival was shorter among patients with MGUS than was expected in a matched control population. (Funded by the National Cancer Institute.)
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              A long-term study of prognosis in monoclonal gammopathy of undetermined significance.

              S Rajkumar, L. Joseph Melton, Erik Larson … (2002)
              A monoclonal gammopathy of undetermined significance (MGUS) occurs in up to 2 percent of persons 50 years of age or older. Reliable predictors of progression have not been identified, and information on prognosis is limited. We identified 1384 patients residing in southeastern Minnesota in whom MGUS was diagnosed at the Mayo Clinic from 1960 through 1994. The primary end point was progression to multiple myeloma or another plasma-cell cancer. During 11,009 person-years of follow-up, MGUS progressed in 115 of the 1384 patients to multiple myeloma, IgM lymphoma, primary amyloidosis, macroglobulinemia, chronic lymphocytic leukemia, or plasmacytoma (relative risk of progression, 25.0, 2.4, 8.4, 46.0, 0.9, and 8.5, respectively). The overall relative risk of progression was 7.3 in these patients as compared with the white population of the Iowa Surveillance, Epidemiology, and End Results program. In 32 additional patients, the monoclonal protein concentration increased to more than 3 g per deciliter or the percentage of plasma cells in the bone marrow increased to more than 10 percent (smoldering multiple myeloma) but without progression to overt myeloma or related disorders. The cumulative probability of progression was 12 percent at 10 years, 25 percent at 20 years, and 30 percent at 25 years. The initial concentration of serum monoclonal protein was a significant predictor of progression at 20 years. The risk of progression of MGUS to multiple myeloma or related disorders is about 1 percent per year.
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                Author and article information

                Contributors
                Peng Liu: liu.peng@zs-hospital.sh.cn
                Journal
                Journal ID (nlm-ta): J Cardiovasc Transl Res
                Journal ID (iso-abbrev): J Cardiovasc Transl Res
                Title: Journal of Cardiovascular Translational Research
                Publisher: Springer US (New York )
                ISSN (Print): 1937-5387
                ISSN (Electronic): 1937-5395
                Publication date (Electronic): 3 January 2020
                Publication date PMC-release: 3 January 2020
                Publication date (Print): 2020
                Volume: 13
                Issue: 5
                Pages: 806-812
                Affiliations
                [1 ]GRID grid.413087.9, ISNI 0000 0004 1755 3939, Department of Hematology, , Zhongshan Hospital Fudan University, ; 180 Fenglin Road, Shanghai, 200032 China
                [2 ]GRID grid.46078.3d, ISNI 0000 0000 8644 1405, Department of Statistics and Actuarial Science, , University of Waterloo, ; Waterloo, Canada
                [3 ]GRID grid.413087.9, ISNI 0000 0004 1755 3939, Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, , Zhongshan Hospital Fudan University, ; Shanghai, China
                Author notes

                Associate Editor Angela Taylor oversaw the review of this article

                Article
                Publisher ID: 9950
                DOI: 10.1007/s12265-019-09950-w
                PMC ID: 7541390
                PubMed ID: 31900894
                SO-VID: 2e62dee8-0434-4e37-8286-bf807c77ae13
                Copyright © © The Author(s) 2020, corrected publication February 2020
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 28 July 2019
                Date accepted : 11 December 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81570123
                Award Recipient :
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature 2020

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: mgus,prognosis,coronary artery disease,nomogram
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: mgus, prognosis, coronary artery disease, nomogram

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