Chief Medical Resident Yale University Waterbury, Connecticut, United States
Introduction: Monoclonal gammopathy (MG) encompasses a spectrum of related diseases, with monoclonal gammopathy of undetermined significance (MGUS) being the most prevalent, serving as a precursor of smoldering and clinical multiple myeloma. While the association between gammopathies, metabolic conditions and antigenic stimulation has long been recognized, the precise etiopathogenic mechanism remains to be elucidated. The aim of this study is to assess the prevalence of metabolic comorbidities and viral infections in a large population with monoclonal gammopathy, providing insights into the disease’s pathophysiology.
Methods: We conducted a retrospective chart review at a single center for patients aged 18 years and older, diagnosed with monoclonal gammopathy between 2014 and 2020. We excluded patients without documented immunofixation or serum protein electrophoresis studies, as well as those with “faint” or “extremely faint’’ monoclonal components, resulting in a final data set of 1515 patients. Variables of interest including age, race, ethnicity, gender, hyperlipidemia, diabetes, BMI, HIV, human papillomavirus (HPV), hepatitis C (HCV) and hepatitis B (HBV) status were identified by a combination of direct extraction from the EMR by the Joint Data Analytics Team and manual review of laboratory values, provider notes and scanned documents.
Results: Among the 1515 patients diagnosed with monoclonal gammopathy, the average age was 76.36 (11.3) years. The majority of patients (79.4%) self-identified as White, while 238 (15.7%) as Black/African American and 10 (0.7%) as Asian. Non-Hispanic individuals accounted for 1428 (94.3%) of the patients. The mean body mass index (BMI) was 27.5 (6.73) years. Diabetes mellitus was reported in 614 (40.5%) cases, and hyperlipidemia was observed in 1362 (89.9%) cases. A total of 1236 (81.6%) patients used a statin at some point. Dyslipidemia and diabetes are estimated to affect 53% and 11.3% of the U.S. population, respectively. Among individuals aged 65 and older, the prevalence of dyslipidemia and diabetes is reported to be 60.3% and 21.2%, respectively. In our cohort, viral comorbidities included HIV in 20 (1.3%) patients and HPV in 14 (0.9 %) patients. In comparison, 12.6 per 100,000 people in the U.S. had HIV in 2019. Additionally, 49 out of 812 (6%) patients had positive HCV antibodies, compared to 1.7% of US adults. There were 56 of 711 (7.9%) patients with HBV infections. As of May 2023, out of the total 1515 patients, 485 (32%) deaths were reported.
Conclusions: Patients with MG demonstrate significantly higher rates of dyslipidemia, diabetes, HIV, and positive HCV antibodies compared to the general US adult population. These findings highlight the importance of metabolic and viral infections in MG and emphasize the need for additional research on biologic drivers to guide preventative strategies.
