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Autografting

Secondary MGUS after autologous hematopoietic progenitor cell transplantation in plasma cell myeloma: a matter of undetermined significance

Bone Marrow Transplantation volume 47, pages 1212–1216 (2012)Cite this article

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Abstract

Plasma cell myeloma, characterized by clonally aberrant plasma cells that produce abnormal monoclonal Igs, is the most common indication for autologous hematopoietic progenitor cell transplantation (AHPCT) in North America. We observed appearance of new monoclonal gammopathies different from the original protein in the post-AHPCT setting and termed this condition ‘secondary MGUS’ (monoclonal gammopathy of undetermined significance). Hence, we performed a retrospective, single institution review of serum protein electrophoresis/immunofixation electrophoresis data in 92 AHPCT recipients from the period 2000–2009. In all, 22 of 92 patients (24%) undergoing AHPCT met criteria for secondary MGUS. Contrary to previous studies, often referred to as ‘abnormal protein banding,’ we did not observe this condition as a favorable prognostic indicator in affected patients when compared with the control group (P=0.686). However, we did note that a subgroup of the study cohort who developed secondary MGUS after a prolonged latency (>10 months) had an improved median OS compared with the remainder of the study cohort (75 months vs 41 months, P=0.005). As there have been significant advancements in understanding the pathobiology and clinical significance of MGUS, we believe that secondary MGUS merits dedication of resources for investigation to determine its true clinical relevance, prognostic value and pathophysiology.

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References

  1. Landgren O, Kyle RA, Pfeiffer RM, Katzmann JA, Caporaso NE, Hayes RB et al. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood 2009; 113: 5412–5417.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Weiss BM, Abadie J, Verma P, Howard RS, Kuehl WM . A monoclonal gammopathy precedes multiple myeloma in most patients. Blood 2009; 113: 5418–5422.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516–2520.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Gertz MA, Kumar S, Lacy MQ, Dispenzieri A, Dingli D, Hayman SR et al. Stem cell transplantation in multiple myeloma: impact of response failure with thalidomide or lenalidomide induction. Blood 2010; 115: 2348–2353; quiz 2560.

    Article  CAS  PubMed  Google Scholar 

  5. Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL et al. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23: 1904–1912.

    Article  CAS  PubMed  Google Scholar 

  6. Durie BG, Salmon SE . A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842–854.

    Article  CAS  PubMed  Google Scholar 

  7. Lazarus HM, Sommers SR, Arfons LM, Fu P, Ataergin SA, Kaye NM et al. Spontaneous autologous graft-versus-host disease in plasma cell myeloma autograft recipients: Flow cytometric analysis of hematopoietic progenitor cell grafts. Biol Blood Marrow Transplant 2011; 17: 970–978.

    Article  CAS  PubMed  Google Scholar 

  8. Kaplan EL, Meier P . Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  9. Cox DR . Regression models and life tables (with discussion). J Royal Stat Soc Series B 1972; 34: 188–220.

    Google Scholar 

  10. Maisnar V, Tichy M, Smolej L, Zak P, Radocha J, Palicka V et al. Isotype class switching after transplantation in multiple myeloma. Neoplasma 2007; 54: 225–228.

    CAS  PubMed  Google Scholar 

  11. Zent CS, Wilson CS, Tricot G, Jagannath S, Siegel D, Desikan KR et al. Oligoclonal protein bands and Ig isotype switching in multiple myeloma treated with high-dose therapy and hematopoietic cell transplantation. Blood 1998; 91: 3518–3523.

    CAS  PubMed  Google Scholar 

  12. Hovenga S, de Wolf JT, Guikema JE, Klip H, Smit JW, Smit Sibinga CT et al. Autologous stem cell transplantation in multiple myeloma after VAD and EDAP courses: a high incidence of oligoclonal serum Igs post transplantation. Bone Marrow Transplant 2000; 25: 723–728.

    Article  CAS  PubMed  Google Scholar 

  13. Hall SL, Tate J, Gill D, Mollee P . Significance of abnormal protein bands in patients with multiple myeloma following autologous stem cell transplantation. Clin Biochem Rev 2009; 30: 113–118.

    PubMed  PubMed Central  Google Scholar 

  14. Alejandre ME, Madalena LB, Pavlovsky MA, Facio ML, Corrado C, Milone G et al. Oligoclonal bands and immunoglobulin isotype switch during monitoring of patients with multiple myeloma and autologous hematopoietic cell transplantation: a 16-year experience. Clin Chem Lab Med 2010; 48: 727–731.

    Article  CAS  PubMed  Google Scholar 

  15. Sucak G, Suyani E, Ozkurt ZN, Yegin ZA, Aki Z, Yagci M . Abnormal protein bands in patients with multiple myeloma after haematopoietic stem cell transplantation: does it have a prognostic significance? Hematol Oncol 2010; 28: 180–184.

    Article  CAS  PubMed  Google Scholar 

  16. Wadhera RK, Kyle RA, Larson DR, Dispenzieri A, Kumar S, Lazarus HM et al. Incidence, clinical course, and prognosis of secondary monoclonal gammopathy of undetermined significance in patients with multiple myeloma. Blood 2011; 118: 2985–2987.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Mitus AJ, Stein R, Rappeport JM, Antin JH, Weinstein HJ, Alper CA et al. Monoclonal and oligoclonal gammopathy after bone marrow transplantation. Blood 1989; 74: 2764–2768.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology-Oncology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    G V Manson, E Campagnaro, S R Sommers & H M Lazarus

  2. Department of Pathology, Division of Hematology-Oncology, Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    A Balog & D Kaplan

  3. Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA

    P Fu

  4. Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA

    S V Rajkumar

Authors
  1. G V Manson
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  2. E Campagnaro
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  3. A Balog
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  4. D Kaplan
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  5. S R Sommers
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  6. P Fu
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  7. S V Rajkumar
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  8. H M Lazarus
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Correspondence to H M Lazarus.

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Manson, G., Campagnaro, E., Balog, A. et al. Secondary MGUS after autologous hematopoietic progenitor cell transplantation in plasma cell myeloma: a matter of undetermined significance. Bone Marrow Transplant 47, 1212–1216 (2012). https://doi.org/10.1038/bmt.2011.244

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