Monoclonal Gammopathy of Undetermined Significance in Patients With Transthyretin Amyloidosis (ATTR) : Analysis Using the iStopMM Criteria
Copyright © 2022 Elsevier Inc. All rights reserved..
INTRODUCTION: To identify the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in patients with transthyretin amyloid (ATTR). We used the iStopMM study revised reference ranges for serum free light-chain (sFLC) corrected for eGFR to identify ATTR patients with light-chain MGUS (LC-MGUS). Characteristics and frequencies of the ATTR cohort with underlying MGUS was compared to a cohort of MGUS patients without ATTR.
PATIENTS AND METHODS: A retrospective analysis of ATTR and MGUS patients evaluated at our center between January 2014 to December 2021. A total of 149, predominantly male (87.5%) ATTR patients with a median age of 82 were included. This cohort was compared to 228 MGUS patients.
RESULTS: Of the 149 ATTR patients, 27 (18.1%) had coexisting MGUS. Among ATTR patients with MGUS, 12/27 (44%) had LC-MGUS based on sFLC abnormalities assessed using the iStopMM reference ranges. Of the MGUS only cohort, 44/228 (19.3%) met criteria for LC-MGUS. Utilizing the iStopMM reference ranges, 6 ATTR patients did not meet criteria for abnormal sFLCs, uncovering a 20% false-positive rate.
CONCLUSION: We noted higher rates of MGUS, particularly LC-MGUS, among ATTR patients when compared to our MGUS only cohort. The high prevalence remained after utilizing the iStopMM sFLC corrected for eGFR reference ranges. Additionally, 6 ATTR patients with renal-dysfunction would have met MGUS criteria if not evaluated using the iStopMM revised measures. These findings emphasize careful interpretation of sFLC abnormalities and encourage providers to keep ATTR on the differential when work-up uncovers sFLC aberrations.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
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| Enthalten in: |
Clinical lymphoma, myeloma & leukemia - 23(2023), 3 vom: 01. März, Seite 211-217 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lewis, Ellen [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 28.02.2023 Date Revised 20.03.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.clml.2022.12.012 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM351324291 |
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| 100 | 1 | |a Lewis, Ellen |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Monoclonal Gammopathy of Undetermined Significance in Patients With Transthyretin Amyloidosis (ATTR) |b Analysis Using the iStopMM Criteria |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: To identify the prevalence of monoclonal gammopathy of undetermined significance (MGUS) in patients with transthyretin amyloid (ATTR). We used the iStopMM study revised reference ranges for serum free light-chain (sFLC) corrected for eGFR to identify ATTR patients with light-chain MGUS (LC-MGUS). Characteristics and frequencies of the ATTR cohort with underlying MGUS was compared to a cohort of MGUS patients without ATTR | ||
| 520 | |a PATIENTS AND METHODS: A retrospective analysis of ATTR and MGUS patients evaluated at our center between January 2014 to December 2021. A total of 149, predominantly male (87.5%) ATTR patients with a median age of 82 were included. This cohort was compared to 228 MGUS patients | ||
| 520 | |a RESULTS: Of the 149 ATTR patients, 27 (18.1%) had coexisting MGUS. Among ATTR patients with MGUS, 12/27 (44%) had LC-MGUS based on sFLC abnormalities assessed using the iStopMM reference ranges. Of the MGUS only cohort, 44/228 (19.3%) met criteria for LC-MGUS. Utilizing the iStopMM reference ranges, 6 ATTR patients did not meet criteria for abnormal sFLCs, uncovering a 20% false-positive rate | ||
| 520 | |a CONCLUSION: We noted higher rates of MGUS, particularly LC-MGUS, among ATTR patients when compared to our MGUS only cohort. The high prevalence remained after utilizing the iStopMM sFLC corrected for eGFR reference ranges. Additionally, 6 ATTR patients with renal-dysfunction would have met MGUS criteria if not evaluated using the iStopMM revised measures. These findings emphasize careful interpretation of sFLC abnormalities and encourage providers to keep ATTR on the differential when work-up uncovers sFLC aberrations | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Amyloidosis | |
| 650 | 4 | |a Estimated glomerular filtration rate (eGFR) | |
| 650 | 4 | |a Light Chain Monoclonal Gammopathy of Undetermined Significance (LC-MGUS) | |
| 650 | 4 | |a Renal function | |
| 650 | 4 | |a Serum Free light chains sFLC | |
| 650 | 7 | |a Prealbumin |2 NLM | |
| 650 | 7 | |a Immunoglobulin Light Chains |2 NLM | |
| 700 | 1 | |a Lee, Holly |e verfasserin |4 aut | |
| 700 | 1 | |a Fine, Nowell |e verfasserin |4 aut | |
| 700 | 1 | |a Miller, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Hahn, Christopher |e verfasserin |4 aut | |
| 700 | 1 | |a Tay, Jason |e verfasserin |4 aut | |
| 700 | 1 | |a Chhibber, Sameer |e verfasserin |4 aut | |
| 700 | 1 | |a Mahe, Etienne |e verfasserin |4 aut | |
| 700 | 1 | |a Jimenez-Zepeda, Victor H |e verfasserin |4 aut | |
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