13.3.4. Prior knowledge of MGUS improves multiple myeloma survival

Chapter 13

Two large, independent studies by Sigurdardottir et al. [873] and Go et al. [874] assessed the impact of prior knowledge of MGUS diagnosis on MM survival. Sigurdardottir et al. [873] studied MM survival rates from the time of diagnosis for 14,798 patients enrolled in the Swedish Cancer Registry. A total of 2.7% of patients had a prior diagnosis of MGUS. MM patients with a prior knowledge of MGUS had a better median overall survival than those without prior knowledge of MGUS (median survival 2.1 vs. 2.8 years, p<0.01, Figure 13.11A). Similar findings were reported by Go et al. [874] Sigurdardottir concluded that “Our observations stress the importance of clinical follow-up in patients with MGUS, regardless of risk stratification.”

Go and colleagues [874] compared the rates of major complications at cancer diagnosis for patients with a monoclonal gammopathy-associated malignancy (MM, Waldenström’s macroglobulinaemia and lymphoplasmacytic lymphoma) for patients with and without MGUS follow-up. Of the 17,457 study patients, 6% had a prior diagnosis of MGUS. Patients with prior MGUS follow-up experienced significantly fewer complications, including acute kidney injury, hypercalcaemia and fractures (Figure 13.11B).

Although both studies provide support for the practice of MGUS follow-up examinations, a recent commentary by Kyle and Rajkumar [875] stated that prospective studies are now required to confirm the value of MGUS follow-up and the optimal approach to monitor patients.