Monoclonal gammopathy of renal significance (MGRS): Real-world data on outcomes and prognostic factors

Abstract

Monoclonal gammopathy of renal significance (MGRS) is a recognized clinical entity. Literature regarding treatment and its outcomes in MGRS is sparse due to the rarity and misdiagnosis of MGRS. We retrospectively analyzed 280 adults with an MGRS diagnosis from 2003 to 2020 across 19 clinical centers from 12 countries. All cases required renal biopsy for the pathological diagnosis of MGRS. Amyloidosis-related to MGRS (MGRS-A) was present in 180 patients; nonamyloidosis MGRS (MGRS-NA), including a broad spectrum of renal pathologies, was diagnosed in 100 patients. The median overall survival in the studied cohort was 121.0 months (95% CI: 105.0-121.0). Patients with MGRS-A had a shorter overall survival than patients with MGRS-NA (HR = 0.41, 95%CI: 0.25-0.69; p = 0.0007). Both hematologic and renal responses were associated with longer survival. Achievement of ≥VGPR was generally predictive of a renal response (OR = 8.03 95%CI: 4.04-115.96; p < 0.0001), one-fourth of patients with ≥VGPR were renal nonresponders. In MGRS-A, factors associated with poor prognosis included elevated levels of creatinine, beta-2-microglobulin, and hemodialysis at diagnosis. In MGRS-NA, only age >65 years was associated with increased risk of death. Treatments provided similar hematologic response rates in both types of MGRS. Autologous stem cell transplantation led to better response than other treatments. This multicenter and international effort is currently the largest report on MGRS.

FIGURE 1

Overall survival of all patients and amyloidosis‐associated monoclonal gammopathy of renal significance (MGRS‐A) and non‐amyloidosis‐associated gammopathy of renal significance (MGRS‐NA). Overall survival of all patients with monoclonal gammopathy of renal significance (A) and overall survival of patients with MGRS‐A, and MGRS‐NA (B) [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Overall survival and hematological response. Overall survival in the groups with amyloidosis‐associated monoclonal gammopathy of renal significance (A) and non‐amyloidosis‐associated gammopathy of renal significance (B) depending on hematological response.* ‐ Hazard ratio for comparison between survival of patients with ≥VGPR versus ≤PR or PD [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Overall survival and renal response. Overall survival in the groups with amyloidosis‐associated monoclonal gammopathy of renal significance (A) and non‐amyloidosis‐associated gammopathy of renal significance (B) depending on renal response [Color figure can be viewed at wileyonlinelibrary.com]