Predictive Factors And Risk Model Of Disease Progression In Patients With Monoclonal Gammopathy Of Undetermined Significance In A Single Center For 9 Years

Objective:To explore the disease progression rate and related factors in patients with monoclonal gammopathy of undetermined significance(MGUS).To establish a risk model of disease progression of MGUS.Method:Natural language processing(NLP)technology and regular expression(RegEx)technology were used to mine clinical data from medical hospital information system(HIS)of Peking Union Medical College Hospital(PUMCH)and manage unstructured data.MGUS patients diagnosed from January 1,2012 to January 31,2021 were recruited.Demographic information,clinical data and follow-up information were recorded.A Cox regression model was established to evaluate the hazard ratio(HR)of various factors related to progression including multiple myeloma and other plasma cell diseases.According to the screened risk factors,a risk-stratification model was established to calculate the risk of disease progression(PD)under different strata.Results:1.A total of 1288 patients with MGUS were enrolled with a median age of 65 years(21-100),majority over 50 years old(86.3%).During a median follow-up of 41 months(3-127),74 cases developed into plasma cell diseases such as multiple myeloma,Waldenstrom macroglobulinemia,POEMS syndrome and amyloidosis,with an average annual progression rate of 0.54%.2.Univariate analysis of Cox regression model showed that serum M protein≥15g/L(HR=2.933,P=0.001),IgG type M protein(HR=1.709,P=0.040),a history of cancer(HR=5.260,P<0.001),abnormal ratio of serum free light chain(sFLC)(HR=1.260,P=0.013)and high-risk cytogenetic abnormalities(HR=4.692,P=0.027)were risk factors for the disease progression of MGUS.Multivariate analysis showed that serum M protein≥15g/L(HR=2.098,95%CI 1.065-4.132,P=0.032)and a history of cancer(HR 4.368,95%CI 2.134-8.944,P<0.001)were risk factors for disease progression.3.The Cox model was used to establish the risk stratification model.Two risk factors(M protein≥15g/L,a history of cancer)were selected.Compared with low-risk group(M protein<15g/L,no cancer history),the relative risk(RR)of PD in the intermediate-risk group(1 risk factor)and high-risk group(2 risk factors)were 3.18 and 8.90,respectively.The median survival of each group was not reached.The 2-year progression rates were 1%,2.8%and 7.1%,respectively.The 5year progress rates were 4.3%,12.5%and 28.9%,respectively.Conclusion:During past 9 years,the disease progression rate of MGUS in our center is 0.54%per year;which is lower than that of European and American data.We also establish a risk model of disease progression in Chinese MGUS patients,suggesting that quantity of serum M protein and a history of cancer should be mainly considered.