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MGUS Arthritis and Risk

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The question posed by an MGUS patient exemplifies MGUS arthritis and risk. I am posting this question as well as relevant studies in order to clarify the issues.
The mission of PeopleBeatingCancer.org  is to support and educate pre-MM and full MM patients and survivors.
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

“I was diagosed with MGUS 2019. Did get 6 monthly bloodtests but with covid happening never had anymore. I asked this year if I could have regular blood test. Had one a few weeks ago. Dr said the Serum Light Chain Kappa was high 40! But she expected that why. Think the paraprotein was 5.? Lower than before. Google said 2 parts Light chain and Lambada need to be high to progress to Myeloma. Few years ago I asked for printout of test results light chain was 35 so only gone up bit. I have arthritis in spine and hips plus curved spine. Is there cause for concern please. Thank you.”

Hi Sally-

I will address your issues individually below-
I was diagosed with MGUS 2019- I am sorry to learn of your MGUS dx. The key to living with mgus is to determine your risk of progressing to full MM.
Dr said the Serum Light Chain Kappa was high 40!- While a FLC Kappa of 40 is above the normal range, by itself it is not a problem-
But she expected that why. Not sure what you are asking- it is to be expected that a person with pre-myeloma has elevated levels of certain markers- again though the issue is to determine your risk-
Think the paraprotein was 5.? Lower than before. (Few years ago I asked for printout of test results light chain was 35 so only gone up bit) Google said 2 parts Light chain and Lambada need to be high to progress to Myeloma.- Not sure what you are telling me here- a paraprotein of 5 depends on the unit of measurement. 5 or .5?
Google said 2 parts Light chain and Lambada need to be high to progress to Myeloma. Not sure what you are saying here-
I have arthritis in spine and hips plus curved spine. Is there cause for concern please. Thank you. The relationship between MGUS and rheumatic diseases is debated. My experience is that your rheumatic disease made you more susceptible to  MGUS. But again, it is all about your risk of progression to MM.

MGUS Immune Markers Predict Risk of Progression to Multiple Myeloma

“An analysis of data from a longitudinal prospective study has identified levels of Monoclonal Gammopathy of Undetermined Significance (MGUS) immune markers measured in blood predict an individual’s risk for developing multiple myeloma, a rare cancer arising in the bone marrow. These findings were published July 18, 2019, in JAMA Oncology.

Multiple myeloma is consistently preceded by a largely asymptomatic condition known as MGUS, which is detectable in peripheral blood (Langdren, O. et al., 2009). However, relatively few individuals with MGUS will go on to develop multiple myeloma (between 0.5% – 1.0% per year). While it has been suggested that changes in MGUS immune marker levels correlate with progression to multiple myeloma, current risk estimation models are based on data from a single time point.

This new study, a collaborative effort co-led by Drs. Jonathan Hofmann, Ph.D., M.P.H., (DCEG) and Ola Landgren (Memorial Sloan Kettering Cancer Center) followed 685 individuals diagnosed with MGUS using data from the Prostate, Lung, Colorectal, Ovarian (PLCO) Cancer Screening Trial and tracked fluctuations in their marker levels over time.

Using a scoring system based on several characteristics of MGUS, individuals were classified as having a

  • low,
  • intermediate,
  • or high

risk of progression to multiple myeloma. The authors determined low-to-intermediate-risk MGUS can transform into high-risk MGUS and progress to multiple myeloma within five years, and that the risk of progression is not necessarily constant over time. These findings support the need for annual blood testing for MGUS patients, and yearly reassessment of a patient’s clinical risk status. ”

Rheumatologic diseases impact the risk of progression of MGUS to overt multiple myeloma

Discussion-

Here we provide compelling evidence that chronic inflammatory RDs have an impact on the disease biology of MGUS by modulating the risk of transformation, which resulted in a twofold increased probability for the development of MM or related lymphoproliferative malignancies in non-Ab–mediated RDs when compared with the MGUS cohort without RDs.

Our results fit well with recent advancements that emphasize chronic inflammation as a cancer risk factor, and as an additional cancer hallmark.Furthermore, the relevance of MGUS for estimating disease activity and outcome in rheumatic inflammatory diseases is best reflected by its inclusion in the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) and lymphoma risk stratification models in primary Sjögren syndrome.

In conclusion, we found a high prevalence of concomitant chronic inflammatory RDs in MGUS patients.

The risk of progression varied depending on which RDs were diagnosed, and patients with non-Ab–mediated RDs had doubled risk of transformation and a 5-year risk of progression.

Future studies are necessary to further elucidate the impact of proinflammatory processes and immunosuppressive therapies on how MGUS evolves and its risk of progression.”

 

 

 

 

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