Quantitative risk of underlying disease conditions for progression from monoclonal gammopathy to multiple myeloma: a nationwide cohort study

Background: This nationwide real-world data cohort study developed a risk-scoring model to predict the progression of monoclonal gammopathy of undetermined significance (MGUS) to symptomatic multiple myeloma (MM) using prior disease conditions. Materials and methods: The Health Insurance Review and Assessment Service database, which covers nearly the entire Korean population, was utilized in this study. Out of 5361 MGUS patients, 345 (6.4%) were diagnosed with MM, with 253 (73.3%) of them progressing to symptomatic MM. Results: We identified female sex, chronic pulmonary disease, peptic ulcer disease, diabetes, and non-malignant hematologic disorder as significant risk factors and integrated these into the risk-scoring model. MGUS patients can be stratified into low-, intermediate-, and high-risk groups for progression to symptomatic MM using this model. The high-risk group showed a hazard ratio (HR) of 2.53 [95% confidence interval (CI) 1.70-3.75] compared with the low-risk group, and the intermediate-risk group showed an HR of 1.38 (95% CI 1.02-1.86) compared with the low-risk group. Conclusion: This scoring model will help in the early detection of MGUS patients at high risk for symptomatic MM and allow for a more efficient allocation of health care resources to those patients who require intensive monitoring.