Clinical and Psychological Outcomes After Monoclonal Gammopathy Screening : A Population-Based Screening Study and Subsequent Randomized Trial of Follow-Up
(2026) In Journal of clinical oncology : official journal of the American Society of Clinical Oncology- Abstract
Multiple myeloma (MM) and related malignancies develop from an asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS), detectable via blood testing. The benefits and harms of population-based MGUS screening remain uncertain. We conducted a nationwide screening study for monoclonal gammopathies and a randomized trial of follow-up strategies in Iceland (Iceland Screens, Treats, or Prevents Multiple Myeloma; ClinicalTrials.gov identifier: NCT03327597). In total, 75,422 (53% of those invited) were screened and those with MGUS (n = 3,541) were randomly assigned to no notification (arm 1), guideline-based follow-up (arm 2), or intensified follow-up (arm 3). Progression, symptom burden, and psychological... (More)
Multiple myeloma (MM) and related malignancies develop from an asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS), detectable via blood testing. The benefits and harms of population-based MGUS screening remain uncertain. We conducted a nationwide screening study for monoclonal gammopathies and a randomized trial of follow-up strategies in Iceland (Iceland Screens, Treats, or Prevents Multiple Myeloma; ClinicalTrials.gov identifier: NCT03327597). In total, 75,422 (53% of those invited) were screened and those with MGUS (n = 3,541) were randomly assigned to no notification (arm 1), guideline-based follow-up (arm 2), or intensified follow-up (arm 3). Progression, symptom burden, and psychological well-being were compared between the control arm (arm 1) and intervention arms (arms 2 and 3). After a median follow-up of 4.5 years, screening led to a 27-fold increase in the detection of smoldering MM (8.6% v 0.3%; hazard ratio, 27.46 [95% CI, 10.21 to 73.86]; P < .001), but active malignancy rates did not differ. Active MM and related malignancy were diagnosed 1 year earlier in the intervention arms with fewer symptomatic presentations and hospitalizations at diagnosis. MGUS notification was not associated with adverse psychological outcomes. These findings demonstrate that population-based screening facilitates earlier detection of MM and expands access to early intervention without detectable psychological harm. Longer follow-up is required to determine the effects on survival and cost-effectiveness.
(Less)
- author
- publishing date
- 2026-07-14
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- article number
- JCO2502771
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:105047503982
- pmid:42447419
- ISSN
- 0732-183X
- DOI
- 10.1200/JCO-25-02771
- language
- English
- LU publication?
- no
- id
- 3f136038-99f0-46b6-bbf0-702085f4ee39
- date added to LUP
- 2026-07-24 14:58:00
- date last changed
- 2026-09-06 04:01:14
@article{3f136038-99f0-46b6-bbf0-702085f4ee39,
abstract = {{<p>Multiple myeloma (MM) and related malignancies develop from an asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS), detectable via blood testing. The benefits and harms of population-based MGUS screening remain uncertain. We conducted a nationwide screening study for monoclonal gammopathies and a randomized trial of follow-up strategies in Iceland (Iceland Screens, Treats, or Prevents Multiple Myeloma; ClinicalTrials.gov identifier: NCT03327597). In total, 75,422 (53% of those invited) were screened and those with MGUS (n = 3,541) were randomly assigned to no notification (arm 1), guideline-based follow-up (arm 2), or intensified follow-up (arm 3). Progression, symptom burden, and psychological well-being were compared between the control arm (arm 1) and intervention arms (arms 2 and 3). After a median follow-up of 4.5 years, screening led to a 27-fold increase in the detection of smoldering MM (8.6% v 0.3%; hazard ratio, 27.46 [95% CI, 10.21 to 73.86]; P < .001), but active malignancy rates did not differ. Active MM and related malignancy were diagnosed 1 year earlier in the intervention arms with fewer symptomatic presentations and hospitalizations at diagnosis. MGUS notification was not associated with adverse psychological outcomes. These findings demonstrate that population-based screening facilitates earlier detection of MM and expands access to early intervention without detectable psychological harm. Longer follow-up is required to determine the effects on survival and cost-effectiveness.</p>}},
author = {{Rögnvaldsson, Sæmundur and Thorsteinsdóttir, Sigrún and Eythorsson, Elias and Wessman, Inga Dröfn and Sigurdardottir, Gudrun Asta and Vidarsson, Brynjar and Onundarson, Pall T and Agnarsson, Bjarni and Sigurdardottir, Margret and Olafsson, Isleifur and Thorsteinsdottir, Ingunn and Bjornsson, Andri Steinthor and Oskarsson, Jon Thorir and Olafsson, Andri and Gislason, Gauti and Sverrisdottir, Ingigerdur and Long, Thorir and Guðmundsdóttir, Elfa Rún and Thordardottir, Asdis Rosa and Jonsson, Asbjorn and Palsson, Runolfur and Indridason, Olafur S and Hultcrantz, Malin and Durie, Brian G M and Harding, Stephen J and Aspelund, Thor and Landgren, Ola and Love, Thorvardur Jon and Kristinsson, Sigurdur Y}},
issn = {{0732-183X}},
language = {{eng}},
month = {{07}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Journal of clinical oncology : official journal of the American Society of Clinical Oncology}},
title = {{Clinical and Psychological Outcomes After Monoclonal Gammopathy Screening : A Population-Based Screening Study and Subsequent Randomized Trial of Follow-Up}},
url = {{http://dx.doi.org/10.1200/JCO-25-02771}},
doi = {{10.1200/JCO-25-02771}},
year = {{2026}},
}