{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:35:58Z","timestamp":1791909358251,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001840","name":"Icelandic Centre for Research","doi-asserted-by":"publisher","award":["716677"],"award-info":[{"award-number":["716677"]}],"id":[{"id":"10.13039\/501100001840","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA 240139"],"award-info":[{"award-number":["P30 CA 240139"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["173857"],"award-info":[{"award-number":["173857"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100003887","name":"International Myeloma Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100003887","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HemaSphere"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Monoclonal gammopathy of undetermined significance (MGUS) is the precursor of multiple myeloma (MM) and related disorders. MGUS is characterized by asymptomatic paraproteinemia. In some cases, multiple paraproteins can be identified but the clinical implications of this phenomenon are poorly understood. In this study, we aim to inform the approach to this challenging MGUS subgroup by utilizing data from iStopMM, a population\u2010based screening study and randomized trial of follow\u2010up strategies. In total, 75,422 Icelanders over the age of 40 were screened for MGUS with 3389 (4.4%) having at least one paraprotein of whom 303 (9%) had multiple paraproteins. IgM paraproteins were more common in those with multiple paraproteins (49% vs. 27% of paraproteins, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and IgM and non\u2010IgM paraproteins frequently co\u2010occurred (60% of cases). Two\u2010thirds of these participants were randomized to active follow\u2010up where only 31% of multiple paraproteins were persistent. Paraprotein concentrations were mostly independent, and although progression events were few, the progression rate was similar between those with multiple paraproteins and a single paraprotein. In a next\u2010generation flow cytometry (NGF) sub\u2010study, two phenotypically distinct aberrant plasma cell populations could be identified in some with multiple paraproteins. The findings suggest that multiple paraproteins often reflect independent ongoing disease processes that should be monitored independently but otherwise treated similarly to other MGUS cases. Specifically, the findings highlight the need for independent monitoring of IgM and non\u2010IgM paraproteins in these individuals. The study provides novel insights into the management of this understudied MGUS subset.<\/jats:p>","DOI":"10.1002\/hem3.70046","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T09:54:45Z","timestamp":1732010085000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Monoclonal gammopathy of undetermined significance with multiple paraproteins: A population\u2010based screening study"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2162-8414","authenticated-orcid":false,"given":"S\u00e6mundur","family":"R\u00f6gnvaldsson","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f3n \u00de.","family":"\u00d3skarsson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrun","family":"Thorsteinsd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Department of Hematology Rigshospitalet Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malin","family":"Hultcrantz","sequence":"additional","affiliation":[{"name":"Myeloma Service, Department of Medicine Memorial Sloan\u2010Kettering Cancer Center New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Palmason","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Department of Hematology Skane University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingigerdur S.","family":"Sverrisdottir","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Department of Hematology Sahlgrenska University Hospital Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Eythorsson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorir E.","family":"Long","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Department of Nephrology Skane University Hospital Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isleifur","family":"Olafsson","sequence":"additional","affiliation":[{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingunn","family":"Thorsteinsdottir","sequence":"additional","affiliation":[{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brynjar","family":"Vidarsson","sequence":"additional","affiliation":[{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pall T.","family":"Onundarson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjarni A.","family":"Agnarsson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margret","family":"Sigurdardottir","sequence":"additional","affiliation":[{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asbjorn","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Radiology Akureyri Hospital Akureyri Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian G. M.","family":"Durie","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Samuel\u2010Oschin Comprehensive Cancer Institute, Cedar\u2010Sinai Outpatient Cancer Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Harding","sequence":"additional","affiliation":[{"name":"The Binding Site Ltd. Birmingham, West\u2010Midlands UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Landgren","sequence":"additional","affiliation":[{"name":"Myeloma Program, Department of Medicine, Sylvester Comprehensive Cancer Center Univeristy of Miami  Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorvardur J.","family":"Love","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigurdur Y.","family":"Kristinsson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"},{"name":"Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,19]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"211","article-title":"Studies on conditions associated with disturbed gamma globulin formation (gammopathies)","volume":"56","author":"Waldenstrom J","year":"1960","journal-title":"Harvey Lect"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0954-6820.1944.tb03955.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-12-194241"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-12-195008"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2003-03-0801"},{"issue":"21","key":"e_1_2_10_7_1","article-title":"Monoclonal gammopathy of undetermined significance (MGUS) precedes the diagnosis of AL amyloidosis by up to 14 years","volume":"118","author":"Weiss BM","year":"2011","journal-title":"Am Soc Hematol"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa054494"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60482-5"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-08-3449"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)61089-6"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2010.60"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24319"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/32.1.205"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-011-1293-1"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(22)00069-2"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.18866"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-021-00480-w"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.29"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2012.122"},{"issue":"3","key":"e_1_2_10_21_1","first-page":"265","article-title":"Transient paraproteinemia: an intriguing immunological anomaly","volume":"33","author":"Strobel SL","year":"2003","journal-title":"Ann Clin Lab Sci"},{"issue":"5","key":"e_1_2_10_22_1","first-page":"351","article-title":"[Transient monoclonal gammopathies. Study of 34 cases]","volume":"39","author":"Giraldo P","year":"1994","journal-title":"Sangre"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2022-164758"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.283191"}],"container-title":["HemaSphere"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hem3.70046","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T13:31:08Z","timestamp":1738243868000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hem3.70046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":23,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1002\/hem3.70046"],"URL":"https:\/\/doi.org\/10.1002\/hem3.70046","archive":["Portico"],"relation":{},"ISSN":["2572-9241","2572-9241"],"issn-type":[{"value":"2572-9241","type":"print"},{"value":"2572-9241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]},"assertion":[{"value":"2024-04-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70046"}}