Clinical and Psychological Outcomes After Monoclonal Gammopathy Screening: A Population-Based Screening Study and Subsequent Randomized Trial of Follow-Up.

The benefits and harms of population-based MGUS screening remain uncertain.

基于人群的MGUS筛查的好处和危害仍然不确定。

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).

我们在冰岛进行了一项全国性的单克隆免疫球蛋白病筛查研究和随访策略的随机试验（冰岛筛查、治疗或预防多发性骨髓瘤；ClinicalTrials.gov注册号：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).

总共有75,422人（受邀者的53%）接受了筛查，其中MGUS患者（n = 3,541）被随机分配到不通知（第1组）、基于指南的随访（第2组）或加强随访（第3组）。

Progression, symptom burden, and psychological well-being were compared between the control arm (arm 1) and intervention arms (arms 2 and 3).

在对照组（第1组）和干预组（第2组和第3组）之间比较了进展、症状负担和心理福祉。

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.

中位随访4.5年后，筛查导致潜伏性MM的检出率增加了27倍（8.6%对0.3%；风险比，27.46 [95% CI, 10.21至73.86]；P < .001），但活动性恶性肿瘤的比率没有差异。

Active MM and related malignancy were diagnosed 1 year earlier in the intervention arms with fewer symptomatic presentations and hospitalizations at diagnosis.

在干预组中，活动性MM和相关恶性肿瘤的诊断提前了1年，诊断时的症状表现和住院次数较少。

MGUS notification was not associated with adverse psychological outcomes.

MGUS通知并未与不良的心理结果相关联。

These findings demonstrate that population-based screening facilitates earlier detection of MM and expands access to early intervention without detectable psychological harm.

这些发现表明，基于人群的筛查有助于更早地发现多发性骨髓瘤，并扩大了早期干预的途径，而没有明显的心理伤害。

Longer follow-up is required to determine the effects on survival and cost-effectiveness.

需要更长时间的随访来确定其对生存率和成本效益的影响。