Multiple Myeloma, Gammopathies

Bence Jones proteinuria in smoldering multiple myeloma as a predictor marker of progression to symptomatic multiple myeloma

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The diagnosis of smoldering multiple myeloma (SMM) includes patients with a heterogeneous risk of progression to active multiple myeloma (MM): some patients will never progress, whereas others will have a high risk of progression within the first 2 years. Therefore, it is important to improve risk assessment at diagnosis. We conducted a retrospective study in a large cohort of SMM patients, in order to investigate the role of Bence Jones (BJ) proteinuria at diagnosis in the progression to active MM. We found that SMM patients presenting with BJ proteinuria had a significantly shorter median time to progression (TTP) to MM compared with patients without BJ proteinuria (22 vs 88 months, respectively; hazard ratio=2.3, 95% confidence interval=1.4–3.9, P=0.002). We also identified risk subgroups based on the amount of BJ proteinuria: 500 mg/24 h, <500 mg/24 h and without it, with a significantly different median TTP (13, 37 and 88 months, P<0.001). Thus, BJ proteinuria at diagnosis is an independent variable of progression to MM that identifies a subgroup of high-risk SMM patients (51% risk of progression at 2 years) and 500 mg of BJ proteinuria may allow, if validated in another series, to reclassify these patients to MM requiring therapy before the end-organ damage development.

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We thank all the investigators and patients for their participation in this study.

Author contributions

MVM conceived the idea and together with VGC designed the study. VGC, JD, FE, AGC, CA, RL, AB, JMA, RH, JMH and PF provided the data acquisition. VGC and MVM developed the analysis and interpretation of data. VGC drafted the article under the supervision of MVM. MVM, NP, EMO, NG and RGS revised it critically and gave final approval of the version to be submitted. All authors of this paper have read and approved the final version submitted.

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Correspondence to M V Mateos.

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The authors declare no conflict of interest.

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González-Calle, V., Dávila, J., Escalante, F. et al. Bence Jones proteinuria in smoldering multiple myeloma as a predictor marker of progression to symptomatic multiple myeloma. Leukemia 30, 2026–2031 (2016) doi:10.1038/leu.2016.123

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