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April 13, 1984, Vol 251, No. 14 >
ARTICLE | April 13, 1984

'Benign' Monoclonal Gammopathy: Title and subTitle BreakA Misnomer? FREE

Robert A. Kyle, MD
[+] Author Affiliations

Reprint requests to Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Kyle).


JAMA. 1984;251(14):1849-1854. doi:10.1001/jama.1984.03340380031018
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References

A series of 241 patients with monoclonal protein but no evidence of multiple myeloma, macroglobulinemia, amyloidosis, or lymphoma (benign monoclonal gammopathy) were followed up for more than ten years. The patients were classified as follows: group 1, patients without increase of monoclonal serum protein during follow-up (benign) (37%); group 2, patients with greater than 50% increase of monoclonal protein or development of monoclonal urine protein (5%); group 3, patients who died of unrelated causes (39%); and group 4, patients in whom myeloma, macroglobulinemia, amyloidosis, or related diseases developed (19%). The median interval from recognition of the monoclonal protein to diagnosis of multiple myeloma was 98 months; macroglobulinemia, 115 months; and systemic amyloidosis, 92 months. No laboratory or clinical data initially differentiated patients with benign gammopathy from those in whom serious diseases developed. Consequently, serial measurement of serum monoclonal protein is essential.

(JAMA 1984;251:1849-1854)

REFERENCES

1 +
Waldenström J:  Abnormal proteins in myeloma . Adv Intern Med 1952;;5:398-440.
2 +
Waldenström J:  Studies on conditions associated with disturbed gamma globulin formation (gammopathies) . Harvey Lect 1961;;56:211-231.
3 +
Hällén J:  Frequency of 'abnormal' serum globulins (M-components) in the aged . Acta Med Scand 1963;;173:737-744.
4 +
Axelsson U, Bachmann R, Hällén J:  Frequency of pathological proteins (M-components) in 6,995 sera from an adult population . Acta Med Scand 1966;;179;235-247.
5 +
Hällén J:  Discrete gammaglobulin (M-) components in serum: Clinical study of 150 subjects without myelomatosis . Acta Med Scand Suppl 1966;;462:1-127.
6 +
Kyle RA, Finkelstein S, Elveback LR, et al:  Incidence of monoclonal proteins in a Minnesota community with a cluster of multiple myeloma . Blood 1972;;40:719-724.
7 +
Saleun JP, Vicariot M, Deroff P, et al:  Monoclonal gammopathies in the adult population of Finistére, France . J Clin Pathol 1982;; 35:63-68.
8 +
Papadopoulos NM, Elin RJ, Wilson DM:  Incidence of γ-globulin banding in a healthy population by high-resolution electrophoresis . Clin Chem 1982;;28:707-708.
9 +
Kyle RA:  Monoclonal gammopathy of undetermined significance: Natural history in 241 cases . Am J Med 1978;;64:814-826.
10 +
Kyle RA:  Classification and diagnosis of monoclonal gammopathies , in Rose NR, Friedman H (eds): Manual of Clinical Immunology , ed 2. Washington, DC, American Society for Microbiology, 1980;, pp 135-150.
11 +
Kyle RA, Gleich GJ:  IgG subclasses in monoclonal gammopathy of undetermined significance . J Lab Clin Med 1982;;100:806-814.
12 +
Kaplan EL, Meier P:  Nonparametric estimation from incomplete observations . J Am Stat Assoc 1958;;53:457-481.
13 +
Committee of the Chronic Leukemia-Myeloma Task Force, National Cancer Institute:  Proposed guidelines for protocol studies. II. Plasma cell myeloma . Cancer Chemother Rep 1973;;4:145-158.
14 +
Ritzmann SE, Loukas D, Sakai H, et al:  Idiopathic (asymptomatic) monoclonal gammopathies . Arch Intern Med 1975;;135:95-106.
15 +
Kyle RA, Greipp PR:  Smoldering multiple myeloma . N Engl J Med 1980;;302:1347-1349.
16 +
Peltonen S, Wasastjerna C, Wager O:  Clinical features of patients with a serum M component . Acta Med Scand 1978;;203:257-263.
17 +
Lindström FD, Dahlström U:  Multiple myeloma or benign monoclonal gammopathy? A study of differential diagnostic criteria in 44 cases . Clin Immunol Immunopathol 1978;;10:168-174.
18 +
Waldenström J: Diagnosis and Treatment of Multiple Myeloma . New York, Grune & Stratton Inc, 1970;.
19 +
Hobbs JR:  Paraproteins, benign or malignant? Br Med J 1967;;3:699-704.
20 +
Seligmann M, Basch A:  The clinical significance of pathological immunoglobulins , in XII International Congress of Hematology (Plenary Session Papers) . New York, International Society of Hematology, 1968;, pp 21-31.
21 +
Dammacco F, Waldenström J:  Bence Jones proteinuria in benign monoclonal gammopathies: Incidence and characteristics . Acta Med Scand 1968;;184:403-409.
22 +
Kyle RA, Maldonado JE, Bayrd ED:  Idiopathic Bence Jones proteinuria: A distinct entity? Am J Med 1973;;55:222-226.
23 +
Greipp PR, Kyle RA:  Clinical, morphological, and cell kinetic differences among multiple myeloma, monoclonal gammopathy of undetermined significance, and smoldering multiple myeloma . Blood 1983;;62:166-171.
24 +
Santus G, Pirali F, Inzoli MR:  Utilità della fosfatasi acida plasmacellulare nella diagnostica differenziale delle gammopatie monoclonali . Minerva Med 1981;;72:2479-2483.
25 +
Morell A, Riesen W:  Serum β2-microglobulin, serum creatinine and bone marrow plasma cells in benign and malignant monoclonal gammopathy . Acta Haematol 1980;;64:87-93.
26 +
Belleville F, Bertrand F, Nabet P:  β2-Microglobuline et gammapathies monoclonales . Pathol Biol 1978;;26:348-350.
27 +
Garewal H, Durie BGM, Kyle RA, et al:  Serum beta2-microglobulin in the initial staging and subsequent monitoring of monoclonal plasma cell disorders . J Clin Oncol 1984;;2:51-57.
28 +
Shimizu K, Murate T, Kunii A:  Circulating immunoglobulin-secreting cells in patients with plasma cell dyscrasia . Blood 1980;;55:590-594.
29 +
Bast EJEG, Wiringa G, Van Camp B, et al:  Malignancy associated lymphoid cell-markers in monoclonal gammopathy . Protides Biol Fluids 1979;;27:351-356.
30 +
Bast EJEG, Van Camp B, Reynaert P, et al:  Idiotypic peripheral blood lymphocytes in monoclonal gammopathy . Clin Exp Immunol 1982;;47:677-682.
31 +
Mellstedt H, Holm G, Pettersson D, et al:  T cells in monoclonal gammopathies . Scand J Haematol 1982;;29:57-64.

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1 +
Waldenström J:  Abnormal proteins in myeloma . Adv Intern Med 1952;;5:398-440.
2 +
Waldenström J:  Studies on conditions associated with disturbed gamma globulin formation (gammopathies) . Harvey Lect 1961;;56:211-231.
3 +
Hällén J:  Frequency of 'abnormal' serum globulins (M-components) in the aged . Acta Med Scand 1963;;173:737-744.
4 +
Axelsson U, Bachmann R, Hällén J:  Frequency of pathological proteins (M-components) in 6,995 sera from an adult population . Acta Med Scand 1966;;179;235-247.
5 +
Hällén J:  Discrete gammaglobulin (M-) components in serum: Clinical study of 150 subjects without myelomatosis . Acta Med Scand Suppl 1966;;462:1-127.
6 +
Kyle RA, Finkelstein S, Elveback LR, et al:  Incidence of monoclonal proteins in a Minnesota community with a cluster of multiple myeloma . Blood 1972;;40:719-724.
7 +
Saleun JP, Vicariot M, Deroff P, et al:  Monoclonal gammopathies in the adult population of Finistére, France . J Clin Pathol 1982;; 35:63-68.
8 +
Papadopoulos NM, Elin RJ, Wilson DM:  Incidence of γ-globulin banding in a healthy population by high-resolution electrophoresis . Clin Chem 1982;;28:707-708.
9 +
Kyle RA:  Monoclonal gammopathy of undetermined significance: Natural history in 241 cases . Am J Med 1978;;64:814-826.
10 +
Kyle RA:  Classification and diagnosis of monoclonal gammopathies , in Rose NR, Friedman H (eds): Manual of Clinical Immunology , ed 2. Washington, DC, American Society for Microbiology, 1980;, pp 135-150.
11 +
Kyle RA, Gleich GJ:  IgG subclasses in monoclonal gammopathy of undetermined significance . J Lab Clin Med 1982;;100:806-814.
12 +
Kaplan EL, Meier P:  Nonparametric estimation from incomplete observations . J Am Stat Assoc 1958;;53:457-481.
13 +
Committee of the Chronic Leukemia-Myeloma Task Force, National Cancer Institute:  Proposed guidelines for protocol studies. II. Plasma cell myeloma . Cancer Chemother Rep 1973;;4:145-158.
14 +
Ritzmann SE, Loukas D, Sakai H, et al:  Idiopathic (asymptomatic) monoclonal gammopathies . Arch Intern Med 1975;;135:95-106.
15 +
Kyle RA, Greipp PR:  Smoldering multiple myeloma . N Engl J Med 1980;;302:1347-1349.
16 +
Peltonen S, Wasastjerna C, Wager O:  Clinical features of patients with a serum M component . Acta Med Scand 1978;;203:257-263.
17 +
Lindström FD, Dahlström U:  Multiple myeloma or benign monoclonal gammopathy? A study of differential diagnostic criteria in 44 cases . Clin Immunol Immunopathol 1978;;10:168-174.
18 +
Waldenström J: Diagnosis and Treatment of Multiple Myeloma . New York, Grune & Stratton Inc, 1970;.
19 +
Hobbs JR:  Paraproteins, benign or malignant? Br Med J 1967;;3:699-704.
20 +
Seligmann M, Basch A:  The clinical significance of pathological immunoglobulins , in XII International Congress of Hematology (Plenary Session Papers) . New York, International Society of Hematology, 1968;, pp 21-31.
21 +
Dammacco F, Waldenström J:  Bence Jones proteinuria in benign monoclonal gammopathies: Incidence and characteristics . Acta Med Scand 1968;;184:403-409.
22 +
Kyle RA, Maldonado JE, Bayrd ED:  Idiopathic Bence Jones proteinuria: A distinct entity? Am J Med 1973;;55:222-226.
23 +
Greipp PR, Kyle RA:  Clinical, morphological, and cell kinetic differences among multiple myeloma, monoclonal gammopathy of undetermined significance, and smoldering multiple myeloma . Blood 1983;;62:166-171.
24 +
Santus G, Pirali F, Inzoli MR:  Utilità della fosfatasi acida plasmacellulare nella diagnostica differenziale delle gammopatie monoclonali . Minerva Med 1981;;72:2479-2483.
25 +
Morell A, Riesen W:  Serum β2-microglobulin, serum creatinine and bone marrow plasma cells in benign and malignant monoclonal gammopathy . Acta Haematol 1980;;64:87-93.
26 +
Belleville F, Bertrand F, Nabet P:  β2-Microglobuline et gammapathies monoclonales . Pathol Biol 1978;;26:348-350.
27 +
Garewal H, Durie BGM, Kyle RA, et al:  Serum beta2-microglobulin in the initial staging and subsequent monitoring of monoclonal plasma cell disorders . J Clin Oncol 1984;;2:51-57.
28 +
Shimizu K, Murate T, Kunii A:  Circulating immunoglobulin-secreting cells in patients with plasma cell dyscrasia . Blood 1980;;55:590-594.
29 +
Bast EJEG, Wiringa G, Van Camp B, et al:  Malignancy associated lymphoid cell-markers in monoclonal gammopathy . Protides Biol Fluids 1979;;27:351-356.
30 +
Bast EJEG, Van Camp B, Reynaert P, et al:  Idiotypic peripheral blood lymphocytes in monoclonal gammopathy . Clin Exp Immunol 1982;;47:677-682.
31 +
Mellstedt H, Holm G, Pettersson D, et al:  T cells in monoclonal gammopathies . Scand J Haematol 1982;;29:57-64.

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