IgM Monoclonal Gammopathy of Undetermined Significance and Smoldering Waldenström's Macroglobulinemia

doi:10.3816/CLM.2009.n.002

Clinical Lymphoma and Myeloma

Volume 9, Issue 1, March 2009, Pages 17-18

https://doi.org/10.3816/CLM.2009.n.002 Get rights and content

Abstract

Immunoglobulin M monoclonal gammopathy of undetermined significance (IgM-MUS) was diagnosed in 213 Mayo Clinic patients who were residents of 11 counties in southeastern Minnesota from 1960 to 1994. During long-term follow-up, 29 (14%) developed non-Hodgkin lymphoma (n = 17), Waldenström's macroglobulinemia (WM; n = 6), chronic lymphocytic leukemia (n = 3), and AL amyloidosis (n = 3) with relative risks of 15-, 262-, 6-, and 16-fold, respectively. The cumulative probability of progression to one of these disorders was 10% at 5 years, 18% at 10 years, and 24% at 15 years, approximately 1.5% per year. Smoldering WM was identified in 48 patients at Mayo Clinic from 1974 to 1995. During follow-up, 33 of the 48 patients progressed to symptomatic WM. The median time to progression was 4.6 years. The risk of progression to WM was 6% at 1 year, 39% at 3 years, and 55% at 5 years.

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Citation Excerpt :
Studies have also shown that reduced uninvolved Ig as reflected by ↓ GG (excluding M-protein) is associated with poor prognosis e.g. malignant transformation in MGUS [42]. The ↓ GG (excluding M-protein) is particularly prevalent in plasma cell dyscrasia with 8% in MGUS [43], 8% in newly diagnosed multiple myeloma [34], 35% in IgM MGUS and smoldering Waldenström Macroglobulinemia [44], 58–63% in Waldenström Macroglobulinemia [45], and 87–92% in light chain multiple myeloma and non-secretory multiple myeloma [46]. Thus, reporting ↓ GG is not only important in SPE negative patients but also those with a demonstrable M-protein by SPE or other means.
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Hypo-gammaglobulinemia (hypoGG) in serum protein electrophoresis (SPE) reflects, variably, reduced serum immunoglobulin (Ig) concentrations, which may be caused by hematological neoplasms, among other causes. HypoGG in the absence of a discernible M-spike (MC) has been the basis of reflexive testing e.g., by immunofixation electrophoresis (IFE). However, the utility of this practice has not been fully evaluated. Thus, we aimed to (1) determine the predictive power of hypoGG for reduced Ig levels, (2) compare the IFE positive rates and sensitivity between hypoGG and non-hypoGG patients, and (3) examine the M-protein isotype distributions.
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IgM Monoclonal Gammopathy of Undetermined Significance and Smoldering Waldenström's Macroglobulinemia

Abstract

Blood

Mayo Clin Proc

Mayo Clin Proc