Clinical and Psychological Outcomes After Monoclonal Gammopathy Screening: A Population-Based Screening Study and Subsequent Randomized Trial of Follow-Up
Abstract
Multiple myeloma (MM) and related malignancies develop from an asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS), detectable via blood testing. The benefits and harms of population-based MGUS screening remain uncertain. We conducted a nationwide screening study for monoclonal gammopathies and a randomized trial of follow-up strategies in Iceland (Iceland Screens, Treats, or Prevents Multiple Myeloma; ClinicalTrials.gov identifier: NCT03327597 ). In total, 75,422 (53% of those invited) were screened and those with MGUS (n = 3,541) were randomly assigned to no notification (arm 1), guideline-based follow-up (arm 2), or intensified follow-up (arm 3). Progression, symptom burden, and psychological well-being were compared between the control arm (arm 1) and intervention arms (arms 2 and 3). After a median follow-up of 4.5 years, screening led to a 27-fold increase in the detection of smoldering MM (8.6% v 0.3%; hazard ratio, 27.46 [95% CI, 10.21 to 73.86]; P < .001), but active malignancy rates did not differ. Active MM and related malignancy were diagnosed 1 year earlier in the intervention arms with fewer symptomatic presentations and hospitalizations at diagnosis. MGUS notification was not associated with adverse psychological outcomes. These findings demonstrate that population-based screening facilitates earlier detection of MM and expands access to early intervention without detectable psychological harm. Longer follow-up is required to determine the effects on survival and cost-effectiveness.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (29)
Sæmundur Rögnvaldsson
Sigrún Thorsteinsdóttir
Elias Eythorsson
1Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Inga Dröfn Wessman
Faculty of Psychology, University of Iceland, Reykjavik, Iceland
Gudrun Asta Sigurdardottir
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Brynjar Vidarsson
Landspitali University Hospital, Reykjavik, Iceland
Pall T. Onundarson
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Bjarni Agnarsson
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Margret Sigurdardottir
Landspitali University Hospital, Reykjavik, Iceland
Ísleifur Ólafsson
7Department of Clinical Biochemistry and Hematology, Landspítali University Hospital, Reykjavik, Iceland
Ingunn Thorsteinsdottir
Landspitali University Hospital, Reykjavik, Iceland
Andri Steinthor Bjornsson
Faculty of Psychology, University of Iceland, Reykjavik, Iceland
Jon Thorir Oskarsson
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Andri Ólafsson
Gauti Gislason
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Ingigerdur Sverrisdottir
Sahlgrenska University Hospital, Gothenburg, Sweden
Thorir E. Long
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Elfa Rún Guðmundsdóttir
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Asdis Rosa Thordardottir
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Ásbjörn Jónsson
11Department of Radiology, Akureyri Hospital, Akureyri, Iceland
Runolfur Palsson
1Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Olafur S. Indridason
Landspitali University Hospital, Reykjavik, Iceland
Malin Hultcrantz
1Memorial Sloan Kettering Cancer Center, Myeloma Service, Department of Medicine, New York, United States
Brian G.M. Durie
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Outpatient Cancer Center, Los Angeles, CA
Stephen J. Harding
Binding Site Group Ltd Part of Thermo Fisher Scientific, Birmingham, United Kingdom
Thor Aspelund
Ola Landgren
Thorvardur Jon Love
1Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Sigurdur Y. Kristinsson
Faculty of Medicine, University of Iceland, Reykjavik, Iceland