Approaching hypercalcemia in monoclonal gammopathy of undetermined significance: insights from the iStopMM screening study
Year: 2024
Type: article
Abstract: ABSTRACT: Hypercalcemia in monoclonal gammopathy of undetermined significance (MGUS) presents a clinical challenge because it may indicate progression to multiple myeloma (MM) but could also be due to a multitude of unrelated disorders. To inform the approach to this clinical challenge, we conducted a nested cohort study within the Iceland Screens, Treats, or Prevents Multiple Myeloma screening study. Of the 75 422 Icelanders aged 40 years and above who underwent screening for MGUS, we included 2546 with MGUS who were in active follow-up, including regular serum calcium measurements. In total, 191 individuals (7.5%) had hypercalcemia detected at least once, of whom 93 had persistent hypercalcemia (48.7%). MM was found in 3 participants with persistent hypercalcemia (3.2%); all had concurrent bone disease and other end-organ damage. The most common causes of hypercalcemia were primary hyperparathyroidism (56.0%) and malignancies other than MM (16.0%). In this first comprehensive study on hypercalcemia in MGUS, we observed that hypercalcemia rarely indicated MGUS progression and never in the absence of other symptoms of MM. More than half of hypercalcemia cases were transient, and the underlying causes were similar to those in the general population. We conclude that hypercalcemia in MGUS should be approached in the same way as in those without MGUS.
Source: Blood
Authors: Ástrún Helga Jónsdóttir, Helga Ágústa Sigurjónsdóttir, Sigrun Thorsteinsdóttir, Thorir Einarsson Long, Ingigerður Sólveig Sverrisdóttir, Elias Eythorsson, Jón Þórir Óskarsson, Runolfur Palsson, Olafur Skuli Indridason, Brynjar Viðarsson, Pall Torfi Onundarson, Ísleifur Ólafsson, Ingunn Þorsteindóttir, Bjarni A. Agnarsson, Margrét Sigurðardóttir, Ásbjörn Jónsson, Malin Hultcrantz, Brian G. M. Durie, Stephen Harding, Ola Landgren, Thorvardur Jon Love, Sigurður Yngvi Kristinsson, Sæmundur Rögnvaldsson
Institutions: University of Iceland, National University Hospital of Iceland, Rigshospitalet, Skåne University Hospital, Sahlgrenska University Hospital, Akureyri Hospital, Memorial Sloan Kettering Cancer Center, Cedars-Sinai Medical Center, University of Miami, Sylvester Comprehensive Cancer Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: National Cancer Institute
OpenAlex ID: W4405590006