Approaching hypercalcemia in monoclonal gammopathy of undetermined significance: insights from the iStopMM screening study
Hypercalcemia in monoclonal gammopathy of undetermined significance (MGUS) presents a clinical challenge because it may indicate progression to multiple myeloma (MM) but could also be due to a multitude of unrelated disorders. To inform the approach to this clinical challenge, we conducted a nested cohort study within the Iceland Screens, Treats, or Prevents Multiple Myeloma screening study. Of the 75 422 Icelanders aged 40 years and above who underwent screening for MGUS, we included 2546 with MGUS who were in active follow-up, including regular serum calcium measurements. In total, 191 individuals (7.5%) had hypercalcemia detected at least once, of whom 93 had persistent hypercalcemia (48.7%). MM was found in 3 participants with persistent hypercalcemia (3.2%); all had concurrent bone disease and other end-organ damage. The most common causes of hypercalcemia were primary hyperparathyroidism (56.0%) and malignancies other than MM (16.0%). In this first comprehensive study on hypercalcemia in MGUS, we observed that hypercalcemia rarely indicated MGUS progression and never in the absence of other symptoms of MM. More than half of hypercalcemia cases were transient, and the underlying causes were similar to those in the general population. We conclude that hypercalcemia in MGUS should be approached in the same way as in those without MGUS.
Authors
- Sigurður Y. Kristinsson (ORCID: https://orcid.org/0000-0002-4964-7476)
- Elías Eyþórsson (ORCID: https://orcid.org/0000-0002-0277-7628)
- Páll T. Önundarson (ORCID: https://orcid.org/0000-0002-5342-9148)
- Malin L. Hultcrantz (ORCID: https://orcid.org/0000-0002-9045-6495)
- Brynjar Viðarsson
- Helga Ágústa Sigurjónsdóttir (ORCID: https://orcid.org/0000-0002-2921-9853)
- Jón Þórir Óskarsson (ORCID: https://orcid.org/0000-0002-9201-1166)
- Brian G.M. Durie (ORCID: https://orcid.org/0000-0002-9883-3769)
- Þórir Einarsson Long (ORCID: https://orcid.org/0000-0003-2377-7886)
- Stephen E. Harding (ORCID: https://orcid.org/0000-0002-7798-9692)
- Margrét Sigurðardóttir (ORCID: https://orcid.org/0000-0001-8719-0430)
- Ingunn Þorsteinsdóttir
- Ísleifur Ólafsson (ORCID: https://orcid.org/0000-0002-3921-5805)
- Bjarni A. Agnarsson (ORCID: https://orcid.org/0000-0001-7721-9965)
- Runólfur Pálsson (ORCID: https://orcid.org/0000-0001-6763-1702)
- Sigrún Þorsteinsdóttir (ORCID: https://orcid.org/0000-0001-8412-7049)
- Ástrún Helga Jónsdóttir
- Sæmundur Rögnvaldsson (ORCID: https://orcid.org/0000-0003-2162-8414)
- Þorvarður Jón Löve (ORCID: https://orcid.org/0000-0002-2680-6120)
- Ola Landgren (ORCID: https://orcid.org/0000-0001-6485-4839)
- Ólafur S. Indridason (ORCID: https://orcid.org/0000-0001-8509-6598)
- Ásbjörn Jónsson (ORCID: https://orcid.org/0000-0002-2374-9773)
Institutions
- Reykjavík University (IS)
- Cedars-Sinai Medical Center (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of Miami (US)
- University of Iceland (IS)
- Sahlgrenska University Hospital (SE)
- Rigshospitalet (DK)
- Akureyri Hospital (IS)
- National University Hospital of Iceland (IS)
- Skåne University Hospital (SE)
- Sylvester Comprehensive Cancer Center (US)
Publication Details
- Journal
- Blood
- Published
- 2024-12-19
- DOI
- https://doi.org/10.1182/blood.2024025624
- Citations
- 2
- Primary Topic
- Multiple Myeloma Research and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.91