Determining the clinical significance of monoclonal gammopathy of undetermined significance: A SEER-medicare population analysis

Ronald S. Go, Jacob D. Gundrum, Joan M. Neuner

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background Clinical guidelines have recommended annual follow-up examinations of most patients with monoclonal gammopathy of undetermined significance (MGUS); however, evidence supporting this practice is lacking. We performed a population-based study to examine the patterns of disease presentation and outcomes of patients with multiple myeloma, Waldenström macroglobulinemia, and lymphoplasmacytic lymphoma (monoclonal gammopathy-associated malignancies) comparing those with or without a previous MGUS follow-up examination. Materials and Methods Patients with monoclonal gammopathy-associated malignancy from 1994 through 2007 were identified using the Surveillance, Epidemiology, and End Results-Medicare linked database and divided into 2 cohorts: those with follow-up (MGUS follow-up examination preceding the diagnosis) and those with no follow-up (no such follow-up examination). We compared the outcomes, including the rates of major complications at cancer diagnosis (acute kidney injury, cord compression, dialysis use, fracture, and hypercalcemia) and survival using propensity score adjustment and Cox proportional hazard models. All statistical tests were 2-sided. Results Of the 17,457 study patients, 6% had undergone MGUS follow-up. After multivariable modeling, the follow-up group had significantly fewer major complications at diagnosis (odds ratio 0.68; 95% confidence interval [CI], 0.57-0.80) and better disease-specific (median, 38 vs. 29 months, P <.001; hazard ratio [HR] 0.85; 95% CI, 0.76-0.94) and overall (median, 23 vs. 19 months, P <.001; HR 0.87; 95% CI, 0.80-0.95) survival. Conclusion Patients with MGUS follow-up preceding the diagnosis of a monoclonal gammopathy-associated malignancy can experience fewer major complications and have longer survival than those without such follow-up examinations. Future studies replicating our findings in the non-Medicare population and determining the optimal schedule and cost-effectiveness of MGUS follow-up are warranted.

Original languageEnglish (US)
Pages (from-to)177-186.e4
JournalClinical Lymphoma, Myeloma and Leukemia
Volume15
Issue number3
DOIs
StatePublished - Mar 1 2015

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Monoclonal Gammopathy of Undetermined Significance
Medicare
Paraproteinemias
Population
Confidence Intervals
Survival
Neoplasms
Waldenstrom Macroglobulinemia
Propensity Score
Hypercalcemia
Multiple Myeloma
Proportional Hazards Models
Acute Kidney Injury
Cost-Benefit Analysis
Dialysis
Lymphoma
Appointments and Schedules
Epidemiology
Odds Ratio
Databases

Keywords

  • Complications
  • Lymphoplasmacytic lymphoma
  • Multiple myeloma
  • Outcomes
  • Waldenström macroglobulinemia

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

Cite this

Determining the clinical significance of monoclonal gammopathy of undetermined significance : A SEER-medicare population analysis. / Go, Ronald S.; Gundrum, Jacob D.; Neuner, Joan M.

In: Clinical Lymphoma, Myeloma and Leukemia, Vol. 15, No. 3, 01.03.2015, p. 177-186.e4.

Research output: Contribution to journalArticle

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title = "Determining the clinical significance of monoclonal gammopathy of undetermined significance: A SEER-medicare population analysis",
abstract = "Background Clinical guidelines have recommended annual follow-up examinations of most patients with monoclonal gammopathy of undetermined significance (MGUS); however, evidence supporting this practice is lacking. We performed a population-based study to examine the patterns of disease presentation and outcomes of patients with multiple myeloma, Waldenstr{\"o}m macroglobulinemia, and lymphoplasmacytic lymphoma (monoclonal gammopathy-associated malignancies) comparing those with or without a previous MGUS follow-up examination. Materials and Methods Patients with monoclonal gammopathy-associated malignancy from 1994 through 2007 were identified using the Surveillance, Epidemiology, and End Results-Medicare linked database and divided into 2 cohorts: those with follow-up (MGUS follow-up examination preceding the diagnosis) and those with no follow-up (no such follow-up examination). We compared the outcomes, including the rates of major complications at cancer diagnosis (acute kidney injury, cord compression, dialysis use, fracture, and hypercalcemia) and survival using propensity score adjustment and Cox proportional hazard models. All statistical tests were 2-sided. Results Of the 17,457 study patients, 6{\%} had undergone MGUS follow-up. After multivariable modeling, the follow-up group had significantly fewer major complications at diagnosis (odds ratio 0.68; 95{\%} confidence interval [CI], 0.57-0.80) and better disease-specific (median, 38 vs. 29 months, P <.001; hazard ratio [HR] 0.85; 95{\%} CI, 0.76-0.94) and overall (median, 23 vs. 19 months, P <.001; HR 0.87; 95{\%} CI, 0.80-0.95) survival. Conclusion Patients with MGUS follow-up preceding the diagnosis of a monoclonal gammopathy-associated malignancy can experience fewer major complications and have longer survival than those without such follow-up examinations. Future studies replicating our findings in the non-Medicare population and determining the optimal schedule and cost-effectiveness of MGUS follow-up are warranted.",
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T1 - Determining the clinical significance of monoclonal gammopathy of undetermined significance

T2 - A SEER-medicare population analysis

AU - Go, Ronald S.

AU - Gundrum, Jacob D.

AU - Neuner, Joan M.

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N2 - Background Clinical guidelines have recommended annual follow-up examinations of most patients with monoclonal gammopathy of undetermined significance (MGUS); however, evidence supporting this practice is lacking. We performed a population-based study to examine the patterns of disease presentation and outcomes of patients with multiple myeloma, Waldenström macroglobulinemia, and lymphoplasmacytic lymphoma (monoclonal gammopathy-associated malignancies) comparing those with or without a previous MGUS follow-up examination. Materials and Methods Patients with monoclonal gammopathy-associated malignancy from 1994 through 2007 were identified using the Surveillance, Epidemiology, and End Results-Medicare linked database and divided into 2 cohorts: those with follow-up (MGUS follow-up examination preceding the diagnosis) and those with no follow-up (no such follow-up examination). We compared the outcomes, including the rates of major complications at cancer diagnosis (acute kidney injury, cord compression, dialysis use, fracture, and hypercalcemia) and survival using propensity score adjustment and Cox proportional hazard models. All statistical tests were 2-sided. Results Of the 17,457 study patients, 6% had undergone MGUS follow-up. After multivariable modeling, the follow-up group had significantly fewer major complications at diagnosis (odds ratio 0.68; 95% confidence interval [CI], 0.57-0.80) and better disease-specific (median, 38 vs. 29 months, P <.001; hazard ratio [HR] 0.85; 95% CI, 0.76-0.94) and overall (median, 23 vs. 19 months, P <.001; HR 0.87; 95% CI, 0.80-0.95) survival. Conclusion Patients with MGUS follow-up preceding the diagnosis of a monoclonal gammopathy-associated malignancy can experience fewer major complications and have longer survival than those without such follow-up examinations. Future studies replicating our findings in the non-Medicare population and determining the optimal schedule and cost-effectiveness of MGUS follow-up are warranted.

AB - Background Clinical guidelines have recommended annual follow-up examinations of most patients with monoclonal gammopathy of undetermined significance (MGUS); however, evidence supporting this practice is lacking. We performed a population-based study to examine the patterns of disease presentation and outcomes of patients with multiple myeloma, Waldenström macroglobulinemia, and lymphoplasmacytic lymphoma (monoclonal gammopathy-associated malignancies) comparing those with or without a previous MGUS follow-up examination. Materials and Methods Patients with monoclonal gammopathy-associated malignancy from 1994 through 2007 were identified using the Surveillance, Epidemiology, and End Results-Medicare linked database and divided into 2 cohorts: those with follow-up (MGUS follow-up examination preceding the diagnosis) and those with no follow-up (no such follow-up examination). We compared the outcomes, including the rates of major complications at cancer diagnosis (acute kidney injury, cord compression, dialysis use, fracture, and hypercalcemia) and survival using propensity score adjustment and Cox proportional hazard models. All statistical tests were 2-sided. Results Of the 17,457 study patients, 6% had undergone MGUS follow-up. After multivariable modeling, the follow-up group had significantly fewer major complications at diagnosis (odds ratio 0.68; 95% confidence interval [CI], 0.57-0.80) and better disease-specific (median, 38 vs. 29 months, P <.001; hazard ratio [HR] 0.85; 95% CI, 0.76-0.94) and overall (median, 23 vs. 19 months, P <.001; HR 0.87; 95% CI, 0.80-0.95) survival. Conclusion Patients with MGUS follow-up preceding the diagnosis of a monoclonal gammopathy-associated malignancy can experience fewer major complications and have longer survival than those without such follow-up examinations. Future studies replicating our findings in the non-Medicare population and determining the optimal schedule and cost-effectiveness of MGUS follow-up are warranted.

KW - Complications

KW - Lymphoplasmacytic lymphoma

KW - Multiple myeloma

KW - Outcomes

KW - Waldenström macroglobulinemia

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