Impact of prior diagnosis of monoclonal gammopathy on outcomes in newly diagnosed multiple myeloma
Menée aux Etats-Unis à partir de données portant sur 774 patients atteints d'une gammapathie monoclonale de signification indéterminée, d'un myélome asymptomatique ou d'un plasmocytome solitaire diagnostiqués entre 1973 et 2015 et sur 1 548 témoins, cette étude analyse l'association entre l'existence d'une de ces pathologies avant le diagnostic de cancer et la survie globale chez des patients atteints d'un myélome multiple récemment diagnostiqué (durée médiane de suivi : 81 mois)
Multiple myeloma (MM) is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS), smoldering myeloma (SMM), or solitary plasmacytoma (SPC). There is a lack of data regarding impact of these pre-existing monoclonal gammopathies (MGs) on MM outcomes. Patients with prior diagnosis of MGUS, SMM, or PC from 1973 to 2015 (cases) were identified from our institution’s database and compared to those without a known MG (controls). The primary outcome of interest was overall survival (OS). Multivariate analysis was performed to ascertain factors impacting all-cause mortality. We identified 774 patients with a prior diagnosis of MGUS, SMM or SPC (cases) and a control population (1:2) matched for the year of diagnosis (n = 1548). After a median follow-up of 81 months, the cases showed a longer median OS than the controls (71 months vs. 56 months). The improved OS was limited to those with a known prior diagnosis of SMM (80 months) and SPC (95 months), compared to MGUS (60 months). Multivariable analysis revealed that MM patients with known prior MG had less overall mortality than those without, and this was limited to prior SMM/SPC group (HR 0.68, 95% CI: 0.50–0.93), as compared to the MGUS group (HR 0.83, 95% CI: 0.66–1.05).