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. 2012 Nov;87(11):1071-9.
doi: 10.1016/j.mayocp.2012.06.014. Epub 2012 Aug 7.

Incidence of monoclonal gammopathy of undetermined significance and estimation of duration before first clinical recognition

Terry M Therneau  1 , Robert A Kyle, L Joseph Melton 3rd, Dirk R Larson, Joanne T Benson, Colin L Colby, Angela Dispenzieri, Shaji Kumar, Jerry A Katzmann, James R Cerhan, S Vincent Rajkumar
Affiliations

Incidence of monoclonal gammopathy of undetermined significance and estimation of duration before first clinical recognition

Terry M Therneau et al. Mayo Clin Proc. 2012 Nov.

Abstract

Objectives: To determine the incidence of monoclonal gammopathy of undetermined significance (MGUS) in the general population and to estimate the duration of occult MGUS before first diagnosis.

Methods: To estimate incidence we used innovative methods to exploit the Olmsted County, Minnesota, MGUS prevalence data, along with follow-up from a large cohort of patients with clinically detected MGUS. The prevalence cohort consisted of 21,463 persons systematically screened for the presence or absence of MGUS. The clinical cohort consisted of 7472 patients with MGUS diagnosed at Mayo Clinic from January 1, 1990, to May 13, 2010. The incidence of MGUS was estimated using the prevalence estimates, the rate of MGUS progression, and the death rates from MGUS using Markov chain methods.

Results: We estimate that the annual incidence of MGUS in men is 120 per 100,000 population at the age of 50 years and increases to 530 per 100,000 population at the age of 90 years. The rates for women are 60 per 100,000 population at the age of 50 years and 370 per 100,000 population at the age of 90 years. We estimate that 56% of women 70 years of age diagnosed as having MGUS have had the condition for more than 10 years, including 28% for more than 20 years. Corresponding values for men are 55% and 31%, respectively. At 60 years of age, the proportion of prevalent cases that are clinically recognized is 13%. This rate increases to 33% at the age of 80 years.

Conclusion: In addition to an accumulation of cases, the age-related increase in prevalence of MGUS is related to a true increase in incidence with age. When first clinically recognized, MGUS has likely been present in an undetected state for a median duration of more than 10 years.

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Figures

FIGURE 1
FIGURE 1
Prevalence of monoclonal gammopathy of undetermined significance (MGUS) according to age. Error bars indicate 95% confidence intervals. Ages older than 90 years have been collapsed to 90 years of age.
FIGURE 2
FIGURE 2
Incidence model using the prevalence estimates of monoclonal gammopathy of undetermined significance (MGUS), the rate of MGUS progression to multiple myeloma or related malignant neoplasm (δ2), and the death rates (λ1-λ3) as inputs to calculate the incidence (δ1).
FIGURE 3
FIGURE 3
Rate of conversion from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma by the age of the patient. This figure shows the estimated yearly progression of MGUS in patients by current age and M-spike size for a joint fit of men and women. Separate fits of the male and female cohorts were also performed but gave a small increase in the goodness of fit (P=.31).
FIGURE 4
FIGURE 4
Estimated incidence of monoclonal gammopathy of undetermined significance by age and sex. The solid line corresponds to a smoothing spline fit and the dashed line to a linear fit with one knot.
FIGURE 5
FIGURE 5
Fitted vs observed prevalence of monoclonal gammopathy of undetermined significance per 100,000 population by age and sex. The solid line corresponds to a smoothing spline fit and the dashed line to a linear fit with one knot. Circles represent the observed age- and sex-specific prevalence rates from the prevalence cohort.
FIGURE 6
FIGURE 6
Prevalence of monoclonal gammopathy of undetermined significance (MGUS) by population-based testing in Olmsted County, Minnesota, vs clinical detection.
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References

    1. Kyle R.A., Therneau T.M., Rajkumar S.V. A long-term study of prognosis of monoclonal gammopathy of undetermined significance. N Engl J Med. 2002;346(8):564–569. - PubMed
    1. Kyle R.A., Therneau T.M., Rajkumar S.V. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006;354(13):1362–1369. - PubMed
    1. Landgren O., Kyle R.A., Pfeiffer R.M. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood. 2009;113(22):5412–5417. - PMC - PubMed
    1. Kyle R.A., Rajkumar S.V. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009;23(1):3–9. - PMC - PubMed
    1. Hastie T.J., Tibshirani R.J. Generalized Additive Models. Chapman & Hall; New York, NY: 1990. Monographs on Statistics and Applied Probability.

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