Clinical features of patients with monoclonal gammopathy

Year 2021, Volume: 1 Issue: 1, 7 - 15, 29.10.2021

Yeşim Mecitoğlu Yağcı Utku Iltar , Hasan Sözel , Turgay Ulaş , Ozan Salim , Sebahat Özdem , Levent Undar

Abstract

Background
In this study, we aimed to demonstrate ordered immunofixation electrophoresis (IFE) testing for distinct indications from different inpatient and outpatient clinics, interrelate the IFE results and patients’ clinical and laboratory characteristics, and classify the confirmed cases of monoclonal gammopathy (MG).
Methods
We included 4,474 IFE tests conducted between December 2013 and July 2016 in this study. Out of these, the tests of 472 patients with MG were retrospectively evaluated.
Results
The patients’ median age was 64 years (range, 17–90). Seventy-four percent of the IFEs were ordered by Hematology, 13.1% by the General Internal Medicine Department, 5% by other internal medicine departments, and the rest were ordered by different clinics. Moreover, 59.5% of IFEs were ordered as diagnostic workups for multiple myeloma, 13.3% for lymphoma; 2.5% for polyneuropathy, and 0.4% for amyloidosis. Among the patients with definitive diagnosis and MG, 44.5% had plasma cell diseases and 14.6% had lymphoproliferative diseases. The most common non-hematological condition associated with MG was rheumatic disease.
Conclusion
Clinicians should be aware of other indications for ordering IFE in diagnostic workups of rare diseases with different clinical presentations, such as unexplained polyneuropathies or autoimmune diseases, which may be associated with MG.

Keywords

Monoclonal gammopathy, Immunofixation electrophoresis, Plasma cell disorders, Lymphoma, Rheumatologic disorders

References

• Merlini G, Stone MJ. Dangerous small B-cell clones. Blood. 2006 Oct 15;108(8):2520-30. doi: 10.1182/blood-2006-03-001164.
• International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003 Jun;121(5):749-57.
• Gupta R, Dahiya M, Kumar L, Shekhar V, Sharma A, Ramakrishnan L, Sharma OD, Begum A. Prevalence of Monoclonal Gammopathy of Undetermined Significance in India-A Hospital-based Study. Clin Lymphoma Myeloma Leuk. 2018 Sep;18(9):e345-e350. doi: 10.1016/j.clml.2018.06.005.
• Landgren O, Graubard BI, Kumar S, Kyle RA, Katzmann JA, Murata K, Costello R, Dispenzieri A, Caporaso N, Mailankody S, Korde N, Hultcrantz M, Therneau TM, Larson DR, Cerhan JR, Rajkumar SV. Prevalence of myeloma precursor state monoclonal gammopathy of undetermined significance in 12372 individuals 10-49 years old: a population-based study from the National Health and Nutrition Examination Survey. Blood Cancer J. 2017 Oct 20;7(10):e618. doi: 10.1038/bcj.2017.97.
• Sandecká V, Hájek R, Pour L, Špička I, Ščudla V, Gregora E, Radocha J, Walterová L, Kessler P, Zahradová L, Adamová D, Valentova K, Vonke I, Obernauerová J, Starostka D, Wróbel M, Brožová L, Jarkovský J, Mikulášová A, Říhová L, Ševčíková S, Straub J, Minařík J, Adam Z, Krejčí M, Král Z, Maisnar V; Czech Myeloma Group. A first Czech analysis of 1887 cases with monoclonal gammopathy of undetermined significance. Eur J Haematol. 2017 Jul;99(1):80-90. doi: 10.1111/ejh.12894.
• Genzen JR, Murray DL, Abel G, Meng QH, Baltaro RJ, Rhoads DD, Delgado JC, Souers RJ, Bashleben C, Keren DF, Ansari MQ. Screening and Diagnosis of Monoclonal Gammopathies: An International Survey of Laboratory Practice. Arch Pathol Lab Med. 2018 Apr;142(4):507-515. doi: 10.5858/arpa.2017-0128-CP.
• Kyle RA, Therneau TM, Rajkumar SV, Offord JR, Larson DR, Plevak MF, Melton LJ 3rd. A long-term study of prognosis in monoclonal gammopathy of undetermined significance. N Engl J Med. 2002 Feb 21;346(8):564-9. doi: 10.1056/NEJMoa01133202.
• Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Offord JR, Dispenzieri A, Katzmann JA, Melton LJ 3rd. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006 Mar 30;354(13):1362-9. doi: 10.1056/NEJMoa054494.
• Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Melton LJ 3rd. Long-term follow-up of 241 patients with monoclonal gammopathy of undetermined significance: the original Mayo Clinic series 25 years later. Mayo Clin Proc. 2004 Jul;79(7):859-66. doi: 10.4065/79.7.859.
• McShane CM, Murray LJ, Landgren O, O'Rorke MA, Korde N, Kunzmann AT, Ismail MR, Anderson LA. Prior autoimmune disease and risk of monoclonal gammopathy of undetermined significance and multiple myeloma: a systematic review. Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):332-42. doi: 10.1158/1055-9965.EPI-13-0695.
• Brito-Zerón P, Retamozo S, Gandía M, Akasbi M, Pérez-De-Lis M, Diaz-Lagares C, Bosch X, Bové A, Pérez-Alvarez R, Soto-Cárdenas MJ, Sisó A, Ramos-Casals M. Monoclonal gammopathy related to Sjögren syndrome: a key marker of disease prognosis and outcomes. J Autoimmun. 2012 Aug;39(1-2):43-8. doi: 10.1016/j.jaut.2012.01.010.
• Frémeaux-Bacchi V, Guinnepain MT, Cacoub P, Dragon-Durey MA, Mouthon L, Blouin J, Cherin P, Laurent J, Piette JC, Fridman WH, Weiss L, Kazatchkine MO. Prevalence of monoclonal gammopathy in patients presenting with acquired angioedema type 2. Am J Med. 2002 Aug 15;113(3):194-9. doi: 10.1016/s0002-9343(02)01124-5.
• Castelli R, Deliliers DL, Zingale LC, Pogliani EM, Cicardi M. Lymphoproliferative disease and acquired C1 inhibitor deficiency. Haematologica. 2007 May;92(5):716-8. doi: 10.3324/haematol.10769.
• Lipsker D. Monoclonal gammopathy of cutaneous significance: review of a relevant concept. J Eur Acad Dermatol Venereol. 2017 Jan;31(1):45-52. doi: 10.1111/jdv.13847.
• Balderman SR, Lichtman MA. Unusual Manifestations of Monoclonal Gammopathy: I. Ocular Disease. Rambam Maimonides Med J. 2015 Jul 30;6(3):e0026. doi: 10.5041/RMMJ.10211.