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Published on: August 29, 2012
Monoclonal gammopathy of undetermined significance does not affect outcomes in patients undergoing solid organ
Victor H Jimenez-Zepeda1, Raymond L Heilman, Rodney A Engel
1Division of Hematology-Oncology, Mayo Clinic, 13400 E. Shea Boulevard, Scottsdale, AZ 85259, USA.
Background:
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic plasma cell proliferative disorder with a lifelong risk of progression to multiple myeloma or another plasma cell dyscrasia. Despite a high incidence in the general population and an increased relative risk for later malignancy, there are few reports about the clinical course of MGUS or risk profile in long-term immunosuppressed patients.
Methods:
We reviewed 1593 solid organ transplant patients and reported the frequency and outcomes of patients with MGUS identified pretransplant.
Results:
Polyclonal gammopathy pretransplant is common with 17% of all patients and as many as 75% of liver transplant candidates having increased globulins.However, a monoclonal immunoglobulin was identified in only 3% of all solid organ transplant patients pretransplant (n=34). Importantly, in these 34 patients, no cases of progression to multiple myeloma, amyloid, or lymphoma were observed during immune suppression, and there was no association between posttransplant lymphoproliferative disorders and pretransplant MGUS. Death in MGUS patients was not associated with progression of the monoclonal clone or development of posttransplant lymphoproliferative disorders or other malignancy.
Conclusion:
In conclusion, routine testing for MGUS before transplantation is not prognostic nor a contraindication to transplant, and therefore, it is not recommended.
Insights
Routine screening for monoclonal gammopathy of undetermined significance (MGUS) before organ transplant is not recommended. Pretransplant MGUS did not increase the risk of progression to multiple myeloma or other cancers in immunosuppressed patients.
Area of Science:
- Hematology
- Transplant Immunology
- Oncology
Background:
- Monoclonal gammopathy of undetermined significance (MGUS) is a common plasma cell disorder with a known risk of progression.
- Limited data exists on the clinical course and malignancy risk of MGUS in long-term immunosuppressed transplant patients.
Purpose of the Study:
- To determine the frequency and outcomes of MGUS in solid organ transplant recipients.
- To assess the prognostic value of pretransplant MGUS in immunosuppressed patients.
Main Methods:
- Retrospective review of 1593 solid organ transplant patients.
- Analysis of pretransplant MGUS identification and post-transplant clinical outcomes.
Main Results:
- Monoclonal gammopathy was identified in 3% of patients pretransplant (n=34).
- No progression to multiple myeloma, amyloid, or lymphoma was observed in MGUS patients during immunosuppression.
- Pretransplant MGUS was not associated with posttransplant lymphoproliferative disorders or increased malignancy risk.
Conclusions:
- Routine pretransplant screening for MGUS is not recommended.
- Pretransplant MGUS is not a contraindication for solid organ transplantation.
- MGUS does not appear to impact outcomes in immunosuppressed transplant patients.
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