Haematologica 2003 - Supplements

Aim: To identify predictor features of malignant transformation
in a large series of patients with MGUS and prolonged follow-up.
Patients and Methods: Four hundred and thirty-four patients (200
M/234 F; median age: 66 yrs) diagnosed with MGUS in a single
institution from September 1970 to January 2001 with a
minimum follow-up of one year were included in the study. All
patients had a M-protein size 15 g/L) as well as the
percentage of bone marrow plasma cells (i.e. > 5 %) predicted
malignant transformation.
080
CLINICAL EVOLUTION AND PROGNOSTIC FACTORS
IN 300 PATIENTS WITH ASYMPTOMATIC IgM
MONOCLONAL GAMMOPATHY
M.Goldaniga, P.Gobbi, S.Cortelazzo, C.Broglia, A.Guffanti,
E.Oldani, C.Stelitano, B.Bronzino, R.Calori, E.Pogliani,
F.Merli and L.Baldini
1) GISL (Gruppo Italiano Studio Linfomi) 2) Divisione di
Ematologia, Ospedali Riuniti , Bergamo, Italy
Asymptomatic clonal macroglobulinemia (ACM) is currently
classified as an IgM MGUS or indolent Waldenström’s
macroglobulinemia (WM), but its clinical relevance and
propensity to evolve into lymphoid neoplasms is not well defined.
We retrospectively evaluated 300 patients with ACM in order to
identify the clinico–pathological features relating to its evolution
into a symptomatic lymphoid neoplasm requiring treatment and
create a prognostic score capable of distinguishing patient
subgroups with different prognoses. The exclusion criteria were:
1) treatment-requiring conditions (high or rapidly increasing
serum IgM levels, hyperviscosity or systemic symptoms,
organomegaly and/or cytopenia); 2) the presence of an
autoimmune disorder, HCV-related cryoglobulinemia,
amyloidosis or other complications due to tissue deposits of IgM
or clonal IgM leading to MM or low grade nonlymphoplasmacytic
lymphoma; or 3) cases with an uncertain
follow-up or unclear disease evolution or treatment criteria. The
main characteristics at diagnosis are shown in the table.
Variable No. of Value
evaluated
pts
Age in years (mean ± 300 63 ± 11
SD)
M/F (ratio) 300 186/114
Serum MC g/dL 300 1.1 (0.11- 3.0)
(median, min-max)
Hb g/dL (median, 300 13.8 (11.0-17.9)
min-max)
Peripheral
287 2 (0.4-3.6)
lymphocytes x 109/L
(median, min-max)
PLT x 109/L (median, 298 238 (100-627)
min-max)
Serum LDH U/l 187 319 ± 104 (134 -986)
(mean ± SD, minmax)
Serum β2
132 2.504 ± 1.052 (195-7.962)
microglobulin µg/ml
(mean ± SD, minmax)
No.of pts. with 296 21/296 ( 7 )
detectable Bence
Jones proteinuria (%)
No.of pts, with one 258 34/258 ( 13.2 )
serum polyclonal Ig
reduction (%)
Bone marrow
lymphoplasma cells
% (median, min-max)
237 11 ( 3 - 92 )
After a median follow-up of 55 months (6-221), 43/300 patients
(14.7%) required chemotherapy for symptomatic WM (70%),
NHL (18.5%), amyloidosis (7%) or peripheral neuropathy
(4.5%). Five- and 10-year overall survival was 98% and 90%,
and evolution-free-survival 91% and 78%.
The features correlating with evolution to overt
lymphoproliferative disease were: serum clonal IgM
concentration (P