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Monoclonal and oligoclonal gammopathies secondary to allogeneic hematopoietic cell transplantation: a phenomenon associated with an increased survival and frequency of chronic graft-versus-host disease

Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: The occurrence of monoclonal gammopathies (MGs) and oligoclonal gammopathies (OGs; 2 or more monoclonal proteins) might be triggered by such factors as immune recovery following allogeneic hematopoietic cell transplantation (allo‑HCT). It has been suggested that post-allo‑HCT gammopathy is associated with increased survival and frequent occurrence of chronic graft‑versus‑host disease (cGvHD). OBJECTIVES: This study aimed to verify these notions by comparing patients with and without gammopathy and, similarly, patients with MG and OG after allo‑HCT in terms of long‑term survival, the incidence and severity of cGvHD, and patient characteristics. Moreover, we aimed to explain the relation between allo‑HCT, the onset of gammopathy, and cGvHD diagnosis. PATIENTS AND METHODS: Among 241 allo‑HCT recipients evaluated from 2014 to 2024, we identified 36 cases of post-allo‑HCT gammopathy (20 MG and 16 OG). From the remaining allo‑HCT recipients, we selected a case‑by‑case matched control group of patients without gammopathy. Survival was analyzed with the Kaplan-Meier method, the Cox proportional hazards model, and the log‑rank test. RESULTS: The patients with post-allo‑HCT gammopathy had a superior 5‑year overall survival (OS) rate, as compared with the control group (79.6% vs 50.9%; P = 0.02). The frequency of cGvHD was significantly higher in the gammopathy group (odds ratio, 4.02). OG was identified mostly before cGvHD diagnosis (median [interquartile range, IQR], 6.3 [14.2-2.5] months following allo‑HCT), while MG mostly after cGvHD diagnosis (median [IQR], 4.5 [0.9-20] months following allo‑HCT). CONCLUSIONS: Post-allo‑HCT gammopathies (both MG and OG) are associated with better prognosis and increased frequency of cGvHD. There are only minor clinical differences between the patients with post-allo‑HCT MG and OG.
DOI: 10.20452/pamw.17148
Language: English
Subfield: Hematology
Field: Medicine
Open Access status: diamond
OpenAlex ID: W4415800899
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