Monoclonal gammopathy of undetermined significance (MGUS) has been established as a precursor condition for multiple myeloma (MM). And yet, despite the existence of such a warning signal, screening for MGUS in the general population is not routine. Instead, many individuals are incidentally diagnosed with MGUS during unrelated medical evaluations.
For those who have been diagnosed with MGUS, risk of disease progression to MM is determined at a single time point — typically at the time of initial work-up. Only patients who have intermediate- and high-risk MGUS are given annual blood screenings to detect for the presence of the abnormal plasma cells associated with MM.
Neither of these screening approaches takes biological changes into consideration, said Ola Landgren, MD, PhD, professor of medicine and chief of myeloma service at Memorial Sloan Kettering Cancer Center in New York City.
“The literature is built on retrospective studies using 1 data point. For doctors who see many patients in clinic every week, it is quite clear that biological changes can occur.” This leaves gaps in clinical care, Dr Landgren noted. “There is an unmet medical need for risk signature that can be applied to individual patients.”
Dr Landgren recently shared first authorship with Jonathan Hofmann, PhD, MPH, on a study that assessed the long-term alterations that may occur in serum immune markers in patients with stable or progressive MGUS, and in the subtype light-chain MGUS.
Describing the importance of this study, Dr Hoffman — who is an investigator at the occupational and environmental epidemiology branch of the division of cancer epidemiology and genetics at the National Cancer Institute in Bethesda, Maryland — told Cancer Therapy Advisor: “We conducted what is, to our knowledge, the first prospective study to longitudinally investigate changes in characteristics of MGUS over time and progression to multiple myeloma. Our study took advantage of serial blood samples collected in the NCI Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial.”
Of the 77,469 adult participants in the screening arm of the PLCO Cancer Screening Trial, 187 were determined to have MGUS progressing to MM or progressing light-chain MGUS to light-chain MM, and another 498 individuals had stable MGUS or light-chain MGUS (in up to 16 years of follow-up.)