文章：

意义未明的单克隆丙种球蛋白病患者中已确立风险分层模型的纵向评估

Longitudinal assessment of established risk stratification models in patients with monoclonal gammopathy of undetermined significance

原文发布日期：2024-08-27

DOI: 10.1038/s41408-024-01126-3

类型: Article

开放获取: 是

英文摘要：

Risk of progression of monoclonal gammopathy of undetermined significance (MGUS) into multiple myeloma and related plasma cell disorders can be determined by three major risk stratification models, namely Mayo2005, Sweden2014, and NCI2019. This retrospective study of 427 patients with MGUS diagnosed according to the 2014 International Myeloma Working Group criteria aimed to describe and analyze the longitudinal applicability of these risk models. In all three models, the majority of patients remained at their baseline risk group, whereas small numbers of patients migrated to a different risk group. Proportions of patients among risk groups remained stable over time (e.g. Mayo2005 model, low-risk group, at baseline: 43%, after 1, 2, 3, 4, 5, and 8 years: 40%, 37%, 37%, 43%, 44%, and 43%). All three risk models reliably distinguished risk of progression at baseline, upon yearly reassessment (e.g. 1 year from diagnosis) and in time-dependent analyses. Upstaging to a high-risk category was associated with an increased risk of progression in all three models (Mayo2005: hazard ratio [HR] = 5.43, 95% confidence interval [95% CI] 1.21–24.39, p = 0.027; Sweden2014: HR = 13.02, 95% CI 5.25–32.28, p < 0.001; NCI2019: HR = 5.85, 95% CI 2.49–13.74, p < 0.001). Our study shows that MGUS risk stratification models can be applied longitudinally to repeatedly determine and improve individual risk of progression. Patient migration to higher risk categories during follow up should prompt more frequent monitoring in clinical routine.
 

摘要翻译： 

意义未明的单克隆丙种球蛋白病（MGUS）进展为多发性骨髓瘤及相关浆细胞疾病的风险可通过三种主要风险分层模型（即Mayo2005、Sweden2014和NCI2019）进行评估。本研究回顾性分析了根据2014年国际骨髓瘤工作组标准诊断的427例MGUS患者，旨在描述并分析这些风险模型的纵向适用性。在三种模型中，大多数患者维持在基线风险组，少数患者转移至不同风险组。各风险组患者比例随时间保持稳定（例如Mayo2005模型中，低风险组基线占比43%，第1、2、3、4、5、8年后分别为40%、37%、37%、43%、44%、43%）。所有三种风险模型均能可靠区分基线时、年度重新评估（如诊断后1年）及时变分析中的疾病进展风险。在所有模型中，风险升级至高危类别均与进展风险增加相关（Mayo2005：风险比[HR] = 5.43，95%置信区间[95% CI] 1.21–24.39，p = 0.027；Sweden2014：HR = 13.02，95% CI 5.25–32.28，p < 0.001；NCI2019：HR = 5.85，95% CI 2.49–13.74，p < 0.001）。本研究表明MGUS风险分层模型可纵向应用于反复评估并优化个体进展风险的判断。随访期间患者风险类别升级时，临床实践中应加强监测频率。

原文链接：

Longitudinal assessment of established risk stratification models in patients with monoclonal gammopathy of undetermined significance