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Immunoparesis and monoclonal gammopathy of undetermined significance are disassociated in advanced age
Author(s) -
Cherry Benjamin M.,
Costello Rene,
Zingone Adriana,
Burris Jason,
Korde Neha,
Manasanch Elisabet,
Kwok Mary,
Annunziata Christina,
Roschewski Mark J.,
Engels Eric A.,
Landgren Ola
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23355
Subject(s) - monoclonal gammopathy of undetermined significance , multiple myeloma , medicine , gastroenterology , oncology , antibody , monoclonal , immunology , monoclonal antibody
Immunoparesis and a skewed serum free light chain (FLC) ratio are indicators of immune dysfunction predictive of progression from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). Previous studies have reported increased prevalence of MGUS by age, but no study has examined the relationship between immunoparesis and abnormal FLC ratios in the elderly. We screened 453 older adults (median age, 80 years; range, 65–96) to characterize the patterns of immunoparesis and abnormal FLC ratio in relation to MGUS. We defined MGUS in 4.4% of the subjects; the prevalence was 12.5% among individuals of >90 years. In MGUS (vs. non‐MGUS) cases, immunoparesis and abnormal FLC ratios were detected in 70.0% (vs. 49.0%; P = 0.07) and 50.0% (vs. 12.9%; P = 0.0001), respectively. Based on small numbers, MGUS patients with abnormal FLC ratio were borderline ( P = 0.07) more likely to have immunoparesis. Overall, the prevalence of immunoparesis varied in a nonlinear fashion, with lowest frequencies in the youngest and oldest groups. Our observed disassociation between MGUS prevalence and impaired immunoglobulin production suggests that separate mechanisms are involved in the development of MGUS and immunoparesis in advanced age. These findings emphasize the need for molecularly defined methods to characterize myeloma precursor states and better predict progression to MM. Am. J. Hematol. 88:89–92, 2013. © 2012 Wiley Periodicals, Inc.