(Press-News.org) Patients with multiple myeloma (MM) appear to have better survival if they are found to have monoclonal gammopathy of undetermined significance (MGUS) first, the state that precedes MM and which is typically diagnosed as part of a medical workup for another reason, according to a study published online by JAMA Oncology.
Most MGUS cases are never diagnosed; MGUS is characterized by a detectable M protein without evidence for end-organ damage or other related plasma cell or lymphoproliferative disorders. Only a small proportion of MGUS progresses to malignancy, with the annual risk of progression to MM or other related diseases being 0.5 percent to 1 percent on average. Current guidelines recommend, depending on a patient's risk score, lifelong monitoring of people with MGUS to detect progression to MM or related disorders, according to the study background.
Sigurdur Y. Kristinsson, M.D., Ph.D., of the University of Iceland, and coauthors estimated the impact of prior knowledge of MGUS diagnosis and coexisting illnesses on MM survival. The study included all patients diagnosed with MM in Sweden (n=14,798) from 1976 to 2005; 394 patients (2.7 percent) had previously diagnosed MGUS.
Study results show that patients with prior knowledge of MGUS had better overall survival (median 2.8 years) than patients with MM who didn't know when they had MGUS (median survival 2.1 years), although patients with prior knowledge of their MGUS status had more coexisting illnesses. Low M-protein concentration at MGUS diagnosis was associated with poorer MM survival among patients with prior knowledge of MGUS.
The authors speculate the reasons for the prolonged survival in their study is that patients with MGUS are evaluated more often for signs of progression to MM and may be diagnosed and started on therapy for myeloma at an earlier stage.
"Our results reflect the importance of lifelong follow-up for individuals diagnosed as having MGUS, independent of risk score, and highlight the need for better risk models based on the biology of the disease. Patients should receive balanced information stressing not only the overall very low risk of progression to malignant neoplasm but also the symptoms that could signal such development and the need to consult their physician," the study concludes.
(JAMA Oncol. Published online March 5, 2015. doi:10.1001/jamaoncol.2015.23. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: This research was supported by grants from the Swedish Cancer Society and other sources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma
In a related editorial, Robert A. Kyle, M.D., and S. Vincent Rajkumar, M.D., of the Mayo Clinic, Rochester, Minn., write: "It cannot be determined whether MM patients with a known MGUS in the Icelandic study were followed more closely than those in whom a MGUS was not recognized, and hence it is difficult to attribute a causal relationship between follow-up and better prognosis."
"It is interesting to note that patients with a lower M-protein concentration were found to have shorter survival following the diagnosis of MM. However, as noted, it is not possible from the present study to determine any causal relationship between close follow-up or lack thereof of these patients and outcome of MM," they continue.
"We also need studies to address the question of the possible merits of screening for the presence of MGUS in a normal, older population. The cost, inconvenience and anxiety produced by the awareness of potential progression of a recognized MGUS, as well as the low absolute risk of progression (0.5 percent - 1 percent), probably override the possible potential benefit of screening for MGUS," the editorial notes.
(JAMA Oncol. Published online March 5, 2015. doi:10.1001/jamaoncol.2015.33. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
INFORMATION:
Media Advisory: To contact author Sigurdur Y. Kristinsson, M.D., Ph.D., email sigyngvi@hi.is. To contact corresponding commentary author Robert A. Kyle, M.D., call Yusuf (Joe) Dangor at
507-284-5005 or email newsbureau@mayo.edu.
A genetic test for patients with breast cancer that helps to predict the risk of developing metastatic disease and the expected benefits of chemotherapy has been adopted quickly into clinical practice in a study of older patients and it appears to be used consistently within guidelines and equitably across geographic and racial groups, according to a study published online by JAMA Oncology.
The 21-gene recurrence score (RS) assay was approved for coverage in 2006 by the Centers for Medicare & Medicaid Services. The test is meant for patients with estrogen receptor (ER)-positive, ...
Injecting botulinum toxin A (known commercially as Botox) appears to be a safe procedure to improve smiles by restoring lip symmetry in children with facial paralysis, a condition they can be born with or acquire because of trauma or tumor, according to a report published online by JAMA Facial Plastic Surgery.
Botulinum toxin A is an effective treatment in adults to achieve facial symmetry after facial paralysis but few investigators have described its use in children, according to the study background. Severe cases of facial paralysis can require surgical reconstruction, ...
A physician who received an experimental Ebola vaccine after experiencing a needle stick while working in an Ebola treatment unit in Sierra Leone did not develop Ebola virus infection, and there was strong Ebola-specific immune responses after the vaccination, although because of its limited use to date, the effectiveness and safety of the vaccine is not certain, according to a study appearing in JAMA.
On September 26, 2014, a 44-year-old physician from the United States caring for patients in an Ebola treatment unit in Sierra Leone experienced an accidental needle stick, ...
A new study by researchers at the Intermountain Medical Center Heart Institute has found that screening for and treating depression could help to reduce the risk of heart disease in patients with moderate to severe depression.
Researchers at the Intermountain Medical Center Heart Institute, the flagship facility for the Intermountain Healthcare system based in Salt Lake City, analyzed the health records and rates of death, coronary artery disease and stroke of more than 26,000 patients treated by Intermountain over a three-year period.
This is the first study to assess ...
A low-cost antiseptic used to cleanse the cord after birth could help reduce infant death rates in developing countries by 12%, a systematic review published in The Cochrane Library suggests. Authors of the review found that when chlorhexidine was used on babies born outside of a hospital, it reduces the number of newborn babies who died or suffer from infections.
A third of deaths in newborn babies are caused by infections. As one of the World Health Organisation's Essential Medicines, chlorhexidine has been used in hospitals and other medical settings to prevent bacterial ...
More young people than ever are getting most of their information about sexual matters from school, but the majority feel they are not getting all the information they need, and men in particular are missing out, according to new research published in BMJ Open.
The findings come from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), the largest scientific study of sexual health and lifestyles in Britain. The research was carried out by UCL (University College London), the London School of Hygiene & Tropical Medicine, and NatCen Social Research. ...
CHICAGO --- Walking barefoot on sand "felt like walking on glass" for Keith Wenckowski, who has lived with type-one diabetes for more than two decades.
One of the participants in a new Northwestern Medicine study who suffered from painful diabetic neuropathy (PDN), Wenckowski finally found relief from the constant foot pain that required him to wear shoes at all times, even to the beach.
The study found that those with PDN who received two low dose rounds of a non-viral gene therapy called VM202 had significant improvement of their pain that lasted for months.
"I ...
Methane is one hot gas. It's a prominent component of natural gas, an important atmospheric gas, and a product of both biology and chemical reactions. Its presence was recently confirmed in the atmosphere of Mars by NASA's Curiosity Rover and it has made the news both as a critical greenhouse gas and as a groundwater contaminant resulting from fracking. Yet, while methane seems to be everywhere, many questions remain about the reactions that produce and consume this high-energy compound.
"Deciphering the many pathways by which methane is produced is one of the holy grails ...
For the first time, CRISPR-Cas9 gene-editing technology has been employed in a whole organism model to systematically target every gene in the genome. A team of scientists at the Broad Institute and MIT's David H. Koch Institute for Integrative Cancer Research have pioneered the use of this technology to "knock out," or turn off, all genes across the genome systematically in an animal model of cancer, revealing genes involved in tumor evolution and metastasis and paving the way for similar studies in other cell types and diseases. The work appears online March 5 in Cell.
"Genome-scale ...
A molecule found in some plants can combat weight gain induced by a high-fat diet, but only in female mice, not males. 7,8-dihydroxyflavone (7,8-DHF) is thought to mimic the effects of a growth factor induced by exercise.
Emory researchers led by Keqiang Ye, PhD, have shown that female mice treated with 7,8-DHF could consume a high-fat diet without gaining weight. In the mice, 7,8-DHF could increase energy expenditure by acting on muscle cells, without suppressing appetite.
"An equivalent diet pill in humans would allow people to maintain a healthy weight, despite a ...
