Rate of MGUS Progression to Haematological Malignancies: A Systematic Review
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic pre-cancerous condition that precedes plasma cell dyscrasias, including multiple myeloma (MM). Current clinical guidelines report that MGUS's rate of malignant progression to haematological malignancy (HM) is ~1% per year; however, reported rates have varied widely. To address this discrepancy, a systematic review was conducted, investigating MGUS's rate of malignant progression to HM and MM alone. Four electronic databases were searched from inception to 28 March 2024 for articles reporting these outcomes; articles were summarised using meta-analysis and narrative synthesis. Findings were incorporated from n = 46 studies, published between 1991 and 2024 and conducted across n = 17 countries. Median follow-up ranged from 1.3 to 34.2 years and sample sizes ranged from n = 63 to 17,963. In random-effects meta-analysis, n = 13 studies reported on MGUS progression to HM and n = 12 reported on progression to MM. The overall estimates of malignant progression events were 12 per 1000 person-years to HM, equivalent to 1.2% per year (95% CI: 1.0%-1.5%) and 8 per 1000 person-years to MM or 0.8% per year (95% CI: 0.7%-1.1%), with substantial heterogeneity between studies (I2: 96.7% and 95.8%, respectively). Progression rates varied widely in narrative synthesis; at 10 years, studies reported annual MGUS progression rates of 6.6%-33.6% to HM and 7.0%-28.5% to MM. While progression rates aligned with clinical…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 63 participants or records.
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