Natural History Study of Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Myeloma (SMM)



Status:Completed
Conditions:Blood Cancer, Hematology
Therapuetic Areas:Hematology, Oncology
Healthy:No
Age Range:18 - 100
Updated:3/20/2019
Start Date:April 15, 2010

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Background:

- Multiple myeloma is a type of cancer that affects white blood cells and has a poor
long-term survival rate. Two other types of cancer, monoclonal gammopathy of undetermined
significance (MGUS) and smoldering myeloma (SMM), may eventually progress and develop into
multiple myeloma. Researchers are interested in collecting samples from individuals who have
been diagnosed with MGUS and SMM to study possible risk factors for developing multiple
myeloma.

Objectives:

- To study risk factors that may cause MGUS and SMM to progress to multiple myeloma.

Eligibility:

- Individuals at least 18 years of age who have been diagnosed with either MGUS or SMM but do
not have multiple myeloma.

Design:

- Participants will be examined by study researchers at the initial visit, at 6 months
following enrollment, and every 12 months for a maximum of 5 years.

- The following tests may be performed: (1) blood and urine tests, (2) bone marrow
aspiration and biopsy, (3) imaging studies, and (4) a skeletal survey (a series of
skeletal X-rays of the skull, spine, pelvis, ribs, shoulders, upper arm, and thigh
bones).

- Treatment will not be provided as part of this protocol. - Participants will remain on
the study for 5 years, or until their MGUS or SMM progresses to multiple myeloma
requiring treatment.

Background:

- Multiple Myeloma (MM) is an incurable plasma cell neoplasm with a median survival of 3-4
years.

- Monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM)
are premalignant plasma cell proliferative disorders characterized by elevated
monoclonal protein and bone marrow plasma cells. MGUS affects 3.2% of Caucasians over
the age of 50 and has a 1% annual risk of progression to MM. approximately 3000 cases of
SMM are diagnosed annually with a 10% annual risk of progression to MM.

- Current risk stratification schemes rely on serum protein markers and phenotyping by
flow cytometry. While they can differentiate high and low risk patients, they cannot
predict outcome for individual patients, are not integrated with one another, and have
limited direct correlation to biology.

- Paired samples linked to clinical information can advance research into improved risk
stratification, the pathogenesis of MGUS, SMM, and MM, and the potential for an early
treatment window for these incurable diseases.

Objectives:

- To characterize the natural history and prognosis of MGUS and SMM

- To integrate protein markers (including immunoglobulin free light-chains) and
immunophenotyping by flow cytometry with molecular profiles (including gene expression
profiles) and clinical outcomes

- To apply expertise and diagnostic technology to provide improved evaluation, monitoring,
and risk-stratification for patients on this protocol

- To provide paired samples of blood and tissue linked to clinical and molecular
information for pilot translational studies

Eligibility:

- A confirmed diagnosis of MGUS or SMM (based on IMWG diagnostic criteria)

- Age greater than or equal to 18 years

- ECOG performance status in the range of 0-2

- Patients who have a diagnosis of MM are not eligible for this study.

Design:

- This is a prospective cohort study of patients with either MGUS or SMM.

- Following initial evaluation and confirmation of diagnosis, patients will be followed as
clinically indicated, usually at 12 month intervals.

- The primary endpoint is progression to MM requiring treatment.

- Patients may donate cellular products or tissues as appropriate for research purposes.

154 patients with MGUS and 154 patients with SMM will be enrolled on this protocol.

- INCLUSION CRITERIA:

- Diagnosis of MGUS and SMM will be made in accordance with the clinical diagnostic
criteria set forth by the International Myeloma Working Group (Table 1).

- The diagnoses will be confirmed by either serum/urine protein electrophoresis,
immunofixation and light-chain assays; or immunohistochemistry analyses of the bone
marrow biopsy, or a combination of these tests.

- Age greater than or equal to 18 years.

- ECOG performance status of 0-2.

- The patient must be competent to sign an informed consent form.

EXCLUSION CRITERIA:

- A diagnosis of MM as defined as any patient with detectable M-protein in blood and/or
urine, monoclonal plasma cells in the bone marrow, and evidence of end-organ damage (based
on the International Myeloma Working Group s diagnostic CRAB criteria:

hypercalcemia [serum calcium at least 1 mg/dL above the upper limit of normal], renal
failure [creatinine greater than 1.95 mg/dL), anemia (hemoglobin less than 10 g/dL], or
bone lesions [lytic lesions or osteoporosis with compression fractures]).

- Patients who have received previous therapy for MM.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
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from
Bethesda, MD
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