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Patterns of survival and causes of death following a diagnosis of monoclonal gammopathy of undetermined significance: a population-based study

Kristinsson, Sigurdur Y.; Bjorkholm, Magnus; Andersson, Therese M-L; Eloranta, Sandra; Dickman, Paul W.; Goldin, Lynn R.; Blimark, Cecilie; Mellqvist, Ulf-Henrik; Wahlin, Anders and Turesson, Ingemar LU , et al. (2009) In Haematologica 94(12). p.1714-1720
Abstract
Background There are limited data on survival patterns among patients with monoclonal gammopathy of undetermined significance. Design and Methods We compared the survival of 4,259 patients with monoclonal gammopathy of undetermined significance, collected from hematology outpatient units in Sweden, with the survival of the general population by computing relative survival ratios. We also compared causes of death in these patients with those in 16,151 matched controls. Results One-, 5-, 10-, and 15-year relative survival ratios were 0.98 (95% Cl 0.97-0.99), 0.93 (0.91-0.95), 0.82 (0.79-0.84), and 0.70 (0.64-0.76), respectively. Younger age at diagnosis of the gammopathy was associated with a significantly lower excess mortality compared to... (More)
Background There are limited data on survival patterns among patients with monoclonal gammopathy of undetermined significance. Design and Methods We compared the survival of 4,259 patients with monoclonal gammopathy of undetermined significance, collected from hematology outpatient units in Sweden, with the survival of the general population by computing relative survival ratios. We also compared causes of death in these patients with those in 16,151 matched controls. Results One-, 5-, 10-, and 15-year relative survival ratios were 0.98 (95% Cl 0.97-0.99), 0.93 (0.91-0.95), 0.82 (0.79-0.84), and 0.70 (0.64-0.76), respectively. Younger age at diagnosis of the gammopathy was associated with a significantly lower excess mortality compared to that in older patients (p<0.001). The excess mortality among patients with gammopathy increased with longer follow-up (p<0.0001). IgM (versus IgG/A) gammopathy was associated with a superior survival (p=0.038). Patients with monoclonal gammopathy of undetermined significance had an increased risk of dying from multiple myeloma (hazards ratio (HR)=553; 95% Cl 77-3946), Waldenstrom's macroglobulinemia (HR=infinity), other lymphoproliferative malignancies (6.5; 2.8-15.1), other hematologic malignancies (22.9; 8.9-58.7), amyloidosis (HR=infinity), bacterial infections (3.4; 1.7-6.7), ischemic heart disease (1.3; 1.1-1.4), other heart disorders (1.5; 1.2-1.8), other hematologic conditions (6.9; 2.7-18), liver (2.1; 1.1-4.2), and renal diseases (3.2; 2.0-4.9). Conclusions Our finding of decreased life expectancy in patients with monoclonal gammopathy of undetermined significance, which was most pronounced in the elderly and explained by both malignant transformation and non-malignant causes, is of importance in the understanding and clinical management of this disease. The underlying mechanisms may be causally related to the gammopathy, but may also be explained by underlying disease that led to the detection of the hematologic disease. Our results are of importance since they give a true estimation of survival in patients with monoclonal gammopathy of undetermined significance diagnosed in clinical practice. (Less)
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keywords
sex, older age, survival, prognosis, monoclonal gammopathy of undetermined significance, multiple myeloma, cause of death, population-based
in
Haematologica
volume
94
issue
12
pages
1714 - 1720
publisher
Ferrata Storti Foundation
external identifiers
  • wos:000274405800014
  • scopus:70449474006
ISSN
1592-8721
DOI
10.3324/haematol.2009.010066
language
English
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yes
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52427eae-263e-49c1-b6f5-8869bf6b1190 (old id 1567808)
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2010-03-24 13:20:10
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2017-10-01 04:31:41
@article{52427eae-263e-49c1-b6f5-8869bf6b1190,
  abstract     = {Background There are limited data on survival patterns among patients with monoclonal gammopathy of undetermined significance. Design and Methods We compared the survival of 4,259 patients with monoclonal gammopathy of undetermined significance, collected from hematology outpatient units in Sweden, with the survival of the general population by computing relative survival ratios. We also compared causes of death in these patients with those in 16,151 matched controls. Results One-, 5-, 10-, and 15-year relative survival ratios were 0.98 (95% Cl 0.97-0.99), 0.93 (0.91-0.95), 0.82 (0.79-0.84), and 0.70 (0.64-0.76), respectively. Younger age at diagnosis of the gammopathy was associated with a significantly lower excess mortality compared to that in older patients (p&lt;0.001). The excess mortality among patients with gammopathy increased with longer follow-up (p&lt;0.0001). IgM (versus IgG/A) gammopathy was associated with a superior survival (p=0.038). Patients with monoclonal gammopathy of undetermined significance had an increased risk of dying from multiple myeloma (hazards ratio (HR)=553; 95% Cl 77-3946), Waldenstrom's macroglobulinemia (HR=infinity), other lymphoproliferative malignancies (6.5; 2.8-15.1), other hematologic malignancies (22.9; 8.9-58.7), amyloidosis (HR=infinity), bacterial infections (3.4; 1.7-6.7), ischemic heart disease (1.3; 1.1-1.4), other heart disorders (1.5; 1.2-1.8), other hematologic conditions (6.9; 2.7-18), liver (2.1; 1.1-4.2), and renal diseases (3.2; 2.0-4.9). Conclusions Our finding of decreased life expectancy in patients with monoclonal gammopathy of undetermined significance, which was most pronounced in the elderly and explained by both malignant transformation and non-malignant causes, is of importance in the understanding and clinical management of this disease. The underlying mechanisms may be causally related to the gammopathy, but may also be explained by underlying disease that led to the detection of the hematologic disease. Our results are of importance since they give a true estimation of survival in patients with monoclonal gammopathy of undetermined significance diagnosed in clinical practice.},
  author       = {Kristinsson, Sigurdur Y. and Bjorkholm, Magnus and Andersson, Therese M-L and Eloranta, Sandra and Dickman, Paul W. and Goldin, Lynn R. and Blimark, Cecilie and Mellqvist, Ulf-Henrik and Wahlin, Anders and Turesson, Ingemar and Landgren, Ola},
  issn         = {1592-8721},
  keyword      = {sex,older age,survival,prognosis,monoclonal gammopathy of undetermined significance,multiple myeloma,cause of death,population-based},
  language     = {eng},
  number       = {12},
  pages        = {1714--1720},
  publisher    = {Ferrata Storti Foundation},
  series       = {Haematologica},
  title        = {Patterns of survival and causes of death following a diagnosis of monoclonal gammopathy of undetermined significance: a population-based study},
  url          = {http://dx.doi.org/10.3324/haematol.2009.010066},
  volume       = {94},
  year         = {2009},
}