Blood Condition That Precedes Myeloma Presents Improved Chance for Early Treatment

Monoclonal gammopathy of undetermined significance (MGUS), a precancerous blood condition that rarely progresses to myeloma, can be predicted by a pattern of frequent hospital visits, according to a recent study. Those with the condititon had about twice as many visits to hospitals as other people of the same age; the findings present an opportunity to begin myeloma treatment earlier, thus improving outcomes, researchers said.

The researchers said MGUS, which itself does not require treatment, is often diagnosed incidentally and other symptoms of myeloma are absent, but it is linked to comorbidities and poor survival.

The UK study compared hospital activity of people with MGUS and patients with mature B-cell malignancies with that in the general population. The results were presented at the 2019 NCRI Cancer Conference.

The UK’s Haematological Malignancy Research Network contains 2 population-based cohorts: a patient cohort of hematological malignancies, and a control group made up of individuals matched by age, sex, and area, for cases diagnosed between January 1, 2009, through the end of 2015. Inpatient and outpatient visits from 5 years before to 3 years after diagnosis were counted, excluding hematology.

Over the study period, patients with MGUS (n = 2239) had significantly higher hospital activity rates compared with controls (n = 22,390). Before diagnosis, monthly attendance rates per 100 persons averaged 30.6 (95% CI, 30.3-30.9) among cases and 20.9 (95% CI, 20.9-21.0) in controls, with activity rates in the controls remaining constant over time. The difference was driven by outpatient attendances and activity in cases remained high after diagnosis.

Previous research suggests that people with MGUS are also at risk of being diagnosed with autoimmune disorders, fractures, and infections. Outpatient specialties with high activity before diagnosis (including rheumatology, orthopedics, dermatology, and nephrology) were similar to those found after. This unusual pattern of activity was not seen in any other hematological malignancies or precursor conditions.

The researchers said this finding could assist with earlier diagnosis of myeloma. About 90% of MGUS cases go undiagnosed, said Maxine Lamb, PhD, a research fellow in the department of health sciences at the University of York, who led the study.

“In the majority of people, this condition doesn’t progress to cancer. However, virtually all people with myeloma, as well as a proportion of patients with some types of lymphoma, had MGUS before their cancer developed. That's why we’re interested in spotting this condition,” she said in a statement.

On average, they found that MGUS patients had 31 visits per 100 people per month in the 3 years prior to diagnosis. Among people not diagnosed with MGUS, this figure was 16, meaning that, on average, patients with MGUS were 1.9 times as likely to have an outpatient appointment than people without MGUS.

There were even stronger patterns in certain specialties. Patients with MGUS were 5.5 times more likely to visit a nephrology clinic, 3.7 times more likely to visit rheumatology, and 2.4 times as likely to visit dermatology. These differences increased in the years after patients were diagnosed with MGUS.

Researchers also looked at a different blood condition, called monoclonal B-cell lymphocytosis, that can lead to other types of blood cancer and they did not see this distinctive pattern of hospital visits, suggesting that it may be unique to MGUS.

Reference

Lamb M, Kane E, Smith A, Roman E. Hospital activity before and after diagnosis of monoclonal gammopathy of undetermined significance (MGUS). Presented at: The NCRI Cancer Conference; November 3-5, 2019; Glasgow, UK. Abstract 2571.