PT  - JOURNAL ARTICLE
AU  - Maxine JE Lamb
AU  - Alexandra Smith
AU  - Daniel Painter
AU  - Eleanor Kane
AU  - Timothy Bagguley
AU  - Robert Newton
AU  - Debra Howell
AU  - Gordon Cook
AU  - Ruth de Tute
AU  - Andrew Rawstron
AU  - Russell Patmore
AU  - Eve Roman
TI  - Health impact of monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL): findings from a UK population-based cohort
AID  - 10.1136/bmjopen-2020-041296
DP  - 2021 Feb 01
TA  - BMJ Open
PG  - e041296
VI  - 11
IP  - 2
4099  - http://bmjopen.bmj.com/content/11/2/e041296.short
4100  - http://bmjopen.bmj.com/content/11/2/e041296.full
SO  - BMJ Open2021 Feb 01; 11
AB  - Objective To examine mortality and morbidity patterns before and after premalignancy diagnosis in individuals with monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL) and compare their secondary healthcare activity to that of the general population.Design Population-based patient cohort, within which each patient is matched at diagnosis to 10 age-matched and sex-matched individuals from the general population. Both cohorts are linked to nationwide information on deaths, cancer registrations and Hospital Episode Statistics.Setting The UK’s Haematological Malignancy Research Network, which has a catchment population of around 4 million served by 14 hospitals and a central diagnostic laboratory.Participants All patients newly diagnosed during 2009–2015 with MGUS (n=2193) or MBL (n=561) and their age and sex-matched comparators (n=27 538).Main outcome measures Mortality and hospital inpatient and outpatient activity in the 5 years before and 3 years after diagnosis.Results Individuals with MGUS experienced excess morbidity in the 5 years before diagnosis and excess mortality and morbidity in the 3 years after diagnosis. Increased rate ratios (RRs) were evident for nearly all clinical specialties, the largest, both before and after diagnosis, being for nephrology (before RR=4.29, 95% CI 3.90 to 4.71; after RR=13.8, 95% CI 12.8 to 15.0) and rheumatology (before RR=3.40, 95% CI 3.18 to 3.63; after RR=5.44, 95% CI 5.08 to 5.83). Strong effects were also evident for endocrinology, neurology, dermatology and respiratory medicine. Conversely, only marginal increases in mortality and morbidity were evident for MBL.Conclusions MGUS and MBL are generally considered to be relatively benign, since most individuals with monoclonal immunoglobulins never develop a B-cell malignancy or any other monoclonal protein-related organ/tissue-related disorder. Nonetheless, our findings offer strong support for the view that in some individuals, monoclonal gammopathy has the potential to cause systemic disease resulting in wide-ranging organ/tissue damage and excess mortality.No data are available. Ethical approvals and data restrictions mean that data cannot be shared, but collaborative projects can be undertaken. The corresponding author can be contacted for more information.