Published online 16 July 2009
Haematologica, Vol 94, Issue 12, 1714-1720 doi:10.3324/haematol.2009.010066
Copyright © 2009 by Ferrata Storti Foundation

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Monoclonal Gammopathies

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

Sigurdur Y. Kristinsson¹, Magnus Björkholm¹, Therese M-L Andersson², Sandra Eloranta², Paul W. Dickman², Lynn R. Goldin³, Cecilie Blimark⁴, Ulf-Henrik Mellqvist⁴, Anders Wahlin⁵, Ingemar Turesson⁶, Ola Landgren^1,3

¹ Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
³ National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
⁴ Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
⁵ Cancer Center, Section of Hematology, Umea University Hospital, Umea, Sweden
⁶ Department of Medicine, Section of Hematology, Malmö University Hospital, Malmö, Sweden

Correspondence: Sigurdur Yngvi Kristinsson, M.D., Ph.D., Department of Medicine, Division of Hematology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. E-mail: sigurdur.kristinsson{at}karolins-ka.se

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% CI 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% CI 77–3946), Waldenström’s macroglobulinemia (HR=), other lymphoproliferative malignancies (6.5; 2.8–15.1), other hematologic malignancies (22.9; 8.9–58.7), amyloidosis (HR=), 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.

Key words: monoclonal gammopathy of undetermined significance, multiple myeloma, prognosis, survival, sex, older age, cause of death, population-based.

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