{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:30:03Z","timestamp":1785825003888,"version":"3.56.0"},"reference-count":17,"publisher":"American Society of Hematology","issue":"10","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2003,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Monoclonal gammopathy of undetermined significance (MGUS) can transform to multiple myeloma (MM). In myeloma, mutated VHgenes with sequence homogeneity reveal a postfollicular origin. Previously, some MGUS cases showed mutated VH genes with intraclonal variation, indicating an earlier stage of arrest. We investigated progression from 2 of 2 MGUS to MM, in which VH genes confirmed clonal evolution. In one MGUS case, intraclonal heterogeneity was evident, and transformation to myeloma occurred rapidly with apparent homogeneity in the emergent clone. However, residual MGUS-derived sequences were detectable at this time. Heterogeneity in MGUS does not associate with benign disease, but it indicates an origin from a tumorigenic cell, most likely surface immunoglobulin+, undergoing somatic mutation. The remaining case displayed intraclonal homogeneity at the MGUS stage, conceivably resulting from a self-cloning outgrowth from MGUS with heterogeneity. Transformation can occur at either MGUS stage, but it involves a single cell in which somatic mutation is then silent.<\/jats:p>","DOI":"10.1182\/blood-2002-09-2825","type":"journal-article","created":{"date-parts":[[2003,5,5]],"date-time":"2003-05-05T19:24:00Z","timestamp":1052162640000},"page":"4137-4139","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":20,"title":["Patterns of somatic mutations in VH genes reveal pathways of clonal transformation from MGUS to multiple myeloma"],"prefix":"10.1182","volume":"101","author":[{"given":"Niklas","family":"Zojer","sequence":"first","affiliation":[{"name":"From the Molecular Immunology Group, Tenovus Laboratory, Cancer Sciences Division, Southampton University Hospitals, Southampton, United Kingdom; the First Department of Internal Medicine and Medical Oncology, Wilhelminenspital, Vienna, Austria; and the Division of Hematology and Oncology, Department of Internal Medicine, University Hospital Innsbruck, Innsbruck, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz","family":"Ludwig","sequence":"additional","affiliation":[{"name":"From the Molecular Immunology Group, Tenovus Laboratory, Cancer Sciences Division, Southampton University Hospitals, Southampton, United Kingdom; the First Department of Internal Medicine and Medical Oncology, Wilhelminenspital, Vienna, Austria; and the Division of Hematology and Oncology, Department of Internal Medicine, University Hospital Innsbruck, Innsbruck, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fiegl","sequence":"additional","affiliation":[{"name":"From the Molecular Immunology Group, Tenovus Laboratory, Cancer Sciences Division, Southampton University Hospitals, Southampton, United Kingdom; the First Department of Internal Medicine and Medical Oncology, Wilhelminenspital, Vienna, Austria; and the Division of Hematology and Oncology, Department of Internal Medicine, University Hospital Innsbruck, Innsbruck, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freda K.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"From the Molecular Immunology Group, Tenovus Laboratory, Cancer Sciences Division, Southampton University Hospitals, Southampton, United Kingdom; the First Department of Internal Medicine and Medical Oncology, Wilhelminenspital, Vienna, Austria; and the Division of Hematology and Oncology, Department of Internal Medicine, University Hospital Innsbruck, Innsbruck, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surinder S.","family":"Sahota","sequence":"additional","affiliation":[{"name":"From the Molecular Immunology Group, Tenovus Laboratory, Cancer Sciences Division, Southampton University Hospitals, Southampton, United Kingdom; the First Department of Internal Medicine and Medical Oncology, Wilhelminenspital, Vienna, Austria; and the Division of Hematology and Oncology, Department of Internal Medicine, University Hospital Innsbruck, Innsbruck, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"key":"2019111706001827700_B1","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1056\/NEJMoa01133202","article-title":"A long-term study of prognosis in monoclonal gammopathy of undetermined significance.","volume":"346","author":"Kyle","year":"2002","journal-title":"N Engl J Med."},{"key":"2019111706001827700_B2","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1046\/j.1365-2141.2002.03651.x","article-title":"Long-term follow up with conventional cytogenetics and band 13q14 interphase\/metaphase in situ hybridization monitoring in monoclonal gammopathies of undetermined significance.","volume":"118","author":"Bernasconi","year":"2002","journal-title":"Br J Haematol."},{"key":"2019111706001827700_B3","first-page":"103a","article-title":"Deletion of chromosome 13q is 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