Patients with monoclonal gammopathy of undetermined significance (MGUS) who also have diabetes, anemia, lung disease, or gastric ulcers are found to have a higher risk of developing multiple myeloma.

This is the first time risk factors for MGUS patients progressing to this incurable blood cancer have been identified.

A research team from the Multiple Myeloma Center at the Catholic University of Korea Seoul St. Mary's Hospital's Blood Disease Center said Tuesday that they have identified five risk factors that increase the risk of progression from asymptomatic MGUS to multiple myeloma, a blood cancer. They also developed a “multiple myeloma progression prediction model” that quantifies these factors.

Professors Park Sung-soo (co-corresponding author) and Min Chang-ki (co-author) of the hospital’s Department of Hematology, along with Professors Han Seung-hoon (co-corresponding author) and Choi Soo-in (co-first author) of the Department of Pharmacology at the Catholic University of Korea College of Medicine, jointly conducted the study.

MGUS is a condition where an abnormal monoclonal immunoglobulin (protein) is detected in the blood. Until now, the medical community has generally considered MGUS to be a disease that does not cause symptoms or pathological signs in patients and therefore does not require immediate treatment.

However, since it arises from the abnormal proliferation and accumulation of plasma cells within the bone marrow, it carries an annual risk of approximately 1 percent of progressing into a malignant tumor. Consequently, it has also been viewed as a precursor disease to the blood cancer multiple myeloma.

Therefore, the research team analyzed the prognosis of 5,361 patients diagnosed with MGUS over a 15-year period from 2007 to 2022, utilizing data from the Health Insurance Review and Assessment Service.

The results showed that the risk of malignant progression in MGUS patients was higher than previously known.

Among the entire cohort, 345 patients (6.4 percent) were diagnosed with multiple myeloma. Of those diagnosed with multiple myeloma, 253 patients (73.3 percent) progressed to symptomatic multiple myeloma, presenting with actual symptoms or organ damage.

The risk factors significantly increasing the risk of MGUS progression to multiple myeloma were identified as: female gender, chronic lung disease, peptic ulcer disease, diabetes, and non-neoplastic blood disorders (anemia, thrombocytopenia, etc.).

The research team also developed a scoring system for these risk factors, classifying patients into three groups based on their predicted risk scores: low risk (0-3 points), intermediate risk (4-5 points), and high risk (7 points or more). They confirmed that the high-risk group had more than a 2.5-fold higher risk of being diagnosed with multiple myeloma.

However, despite the high MGUS incidence in Korea, there was no practical tool to identify patients at high risk of progression to blood cancer. Therefore, the research team is freely sharing these results as a web-based application (R-Shiny) to aid early prediction in various clinical settings.

“Among patients diagnosed with MGUS, elderly female patients with the risk factors identified in this study required closer observation even without symptoms,” Professor Park said. “However, the lack of a monitoring system for healthcare providers to observe patients made clinical judgment difficult. This assessment tool, developed by analyzing risk factors, provides the scientific basis for more meticulous tracking and treatment of individual patients.”

Professor Min expressed optimism, saying, “This predictive model quantifies risk based on complex health status rather than single factors. As a tool directly applicable in clinical practice, it can be easily utilized even in primary care settings, enabling the early identification of high-risk MGUS patients.”

This study has garnered international attention as the first quantitative analysis and predictive tool developed using national-level healthcare big data. It was recently published in “ESMO Open” (Impact Factor: 8.3), the official journal of the European Society of Medical Oncology.