Monoklonalna gammapatia o nieokreślonym znaczeniu (mgus) – Charakterystyka, pielęgnacja i opieka

Monoklonalna gammapatia o nieokreślonym znaczeniu (mgus)
Charakterystyka, pielęgnacja i opieka

Monoklonalna gammapatia o nieokreślonym znaczeniu (MGUS) to stan przednowotworowy charakteryzujący się obecnością białka monoklonalnego (białka M) w surowicy poniżej 30 g/L, z mniej niż 10% klonalnych plazmocytów w szpiku kostnym i brakiem uszkodzeń narządowych typowych dla szpiczaka mnogiego. MGUS występuje u ponad 3% populacji białej powyżej 50 roku życia, z wyższą częstością u osób starszych, czarnoskórych mężczyzn oraz pacjentów z rodzinnym wywiadem. Wyróżnia się trzy typy MGUS: nie-IgM (IgG, IgA, IgD), IgM oraz łańcuchów lekkich, z różnym ryzykiem progresji do szpiczaka mnogiego, makroglobulinemii Waldenströma, amyloidozy AL lub chłoniaka. Diagnostyka opiera się na elektroforezie białek surowicy, immunofiksacji, ocenie wolnych łańcuchów lekkich oraz badaniach biochemicznych, a biopsja szpiku i badania obrazowe są wskazane u pacjentów z podwyższonym ryzykiem progresji lub objawami sugerującymi zaawansowaną chorobę.

Monoklonalna gammapatia o nieokreślonym znaczeniu (MGUS) – Wprowadzenie

Monoklonalna gammapatia o nieokreślonym znaczeniu (MGUS) to stan charakteryzujący się obecnością nieprawidłowego białka (zwanego białkiem monoklonalnym lub białkiem M) we krwi. MGUS jest wynikiem zaburzenia w plazmocytach szpiku kostnego, które produkują nadmiar białka monoklonalnego zamiast normalnych przeciwciał. Chociaż MGUS samo w sobie nie jest nowotworem, uznawane jest za stan przednowotworowy ze względu na niewielkie, ale istotne ryzyko progresji do bardziej poważnych schorzeń hematologicznych.¹²

Definicja MGUS obejmuje: stężenie białka monoklonalnego w surowicy poniżej 30 g/L, mniej niż 10% klonalnych plazmocytów w szpiku kostnym oraz brak uszkodzeń narządowych charakterystycznych dla szpiczaka (hiperkalcemia, niewydolność nerek, niedokrwistość lub zmiany kostne). MGUS jest zazwyczaj wykrywane przypadkowo podczas badań krwi wykonywanych z innych powodów, ponieważ większość osób z tym stanem nie doświadcza żadnych objawów.¹²

Epidemiologia MGUS

MGUS występuje u ponad 3% populacji białej powyżej 50 roku życia, a częstość występowania wzrasta wraz z wiekiem. Jest to najczęstsze zaburzenie plazmocytów. Szczególnie wysoką częstość występowania MGUS obserwuje się u osób w wieku 70 lat i starszych. Badania wykazały również, że czarnoskórzy mężczyźni (w tym mężczyźni pochodzenia afrykańskiego) oraz osoby z rodzinnym wywiadem MGUS lub szpiczaka mnogiego mają wyższe ryzyko rozwoju MGUS.¹²

Warto zauważyć, że MGUS jest rzadko spotykane u młodych pacjentów (w wieku poniżej 40 lat), z częstością występowania około 0,3%, co stanowi około 2% wszystkich pacjentów z MGUS. U młodszych pacjentów MGUS często wiąże się z zaburzeniami immunologicznymi, a u ponad 50% z nich MGUS jest diagnozowane właśnie w kontekście tych zaburzeń.¹

Typy MGUS

Istnieją trzy odrębne typy kliniczne MGUS, z których każdy niesie ryzyko progresji do unikatowego pośredniego (bardziej zaawansowanego) stadium przednowotworowego, a następnie do złośliwej dyskrazji plazmocytów lub zaburzenia limfoproliferacyjnego:¹

MGUS nie-IgM (IgG, IgA lub IgD) – Jest to najczęstszy podtyp MGUS, który może prowadzić do tlącego się (bezobjawowego) szpiczaka mnogiego, a następnie do objawowego szpiczaka mnogiego
MGUS IgM – Stanowi około 15% przypadków MGUS i może prowadzić do tlącego się makroglobulinemii Waldenströma i objawowej makroglobulinemii Waldenströma, a rzadziej do chłoniaka lub amyloidozy AL. W rzadkich przypadkach MGUS IgM może przekształcić się w szpiczaka mnogiego IgM
MGUS łańcuchów lekkich – Charakteryzuje się nieprawidłowym stosunkiem wolnych łańcuchów lekkich i może prowadzić do szpiczaka łańcuchów lekkich lub amyloidozy AL

Objawy i manifestacje kliniczne

MGUS zazwyczaj nie powoduje żadnych objawów i jest często wykrywane przypadkowo podczas rutynowych badań krwi. Jednak istnieją pewne stany patologiczne, które mogą być związane z MGUS:¹²

Neuropatia obwodowa – U części pacjentów może wystąpić uszkodzenie nerwów obwodowych powodujące mrowienie, drętwienie lub ból, głównie w palcach, ramionach, stopach lub nogach
Zwiększone ryzyko złamań – Pacjenci z MGUS mają zwiększone ryzyko złamań kości, szczególnie w obrębie kręgosłupa i miednicy
Problemy nerkowe – U niektórych pacjentów białka monoklonalne mogą gromadzić się w tkance nerek, prowadząc do dysfunkcji
Wtórny niedobór odporności – MGUS może wpływać na prawidłowe funkcjonowanie układu odpornościowego, zwiększając podatność na infekcje
Choroby układu sercowo-naczyniowego – Istnieje związek między MGUS a zwiększonym ryzykiem chorób sercowo-naczyniowych

¹²³

Badania wykazały, że neuropatia obwodowa jest rzeczywiście związana z MGUS. W dużym badaniu populacyjnym obejmującym 15 351 osób z MGUS i 58 619 dopasowanych osób z grupy kontrolnej, częstość występowania neuropatii obwodowej była wyższa u uczestników z MGUS niż w grupie kontrolnej (6,5% vs 2,8%).¹

Diagnostyka MGUS

Diagnoza MGUS opiera się na wykryciu białka monoklonalnego w surowicy lub moczu, przy jednoczesnym braku objawów lub oznak szpiczaka mnogiego lub innych powiązanych stanów. Podstawowe badania diagnostyczne obejmują:¹²

Elektroforezę białek surowicy (SPEP) – do wykrycia i ilościowego oznaczenia białka monoklonalnego
Immunofiksację – do określenia typu białka monoklonalnego
Badanie wolnych łańcuchów lekkich w surowicy – do oceny stosunku kappa/lambda
Pełną morfologię krwi, poziom kreatyniny, wapnia i inne badania biochemiczne
Badanie moczu na obecność białka Bence’a Jonesa

¹²

Biopsja szpiku kostnego

Biopsja szpiku kostnego nie jest rutynowo zalecana u wszystkich pacjentów z MGUS, szczególnie u tych z niskim ryzykiem. Jednak badanie to może być wskazane w przypadku:¹

Pacjentów z pośrednim i wysokim ryzykiem progresji
Pacjentów z nieprawidłowym stosunkiem wolnych łańcuchów lekkich
Pacjentów, u których występują objawy sugerujące progresję do bardziej zaawansowanej choroby
Pacjentów ze stężeniem białka monoklonalnego ≥15 g/L
Pacjentów z paraproteiną inną niż IgG

¹²

Badania obrazowe

Badania obrazowe nie są rutynowo zalecane u wszystkich pacjentów z MGUS, ale mogą być wskazane w przypadku:

Pacjentów z bólem kostnym lub innymi objawami sugerującymi uszkodzenie kości
Pacjentów z umiarkowanym lub wysokim ryzykiem progresji
Oceny gęstości mineralnej kości ze względu na zwiększone ryzyko złamań

¹²

Ze względu na zwiększone ryzyko złamań, zaleca się wyjściową ocenę za pomocą przeglądowego badania radiologicznego układu kostnego (tj. zdjęcia rentgenowskie czaszki, kości długich, kręgosłupa, miednicy i żeber) oraz badanie gęstości kości.¹

Stratyfikacja ryzyka progresji

Pacjenci z MGUS mogą być poddani stratyfikacji ryzyka na podstawie ilości i typu białka monoklonalnego oraz tego, czy mają nieprawidłowy stosunek wolnych łańcuchów lekkich. Czynniki ryzyka progresji obejmują:¹²

Stężenie białka monoklonalnego ≥15 g/L
Typ białka monoklonalnego inny niż IgG (np. IgA, IgM)
Nieprawidłowy stosunek wolnych łańcuchów lekkich (kappa/lambda)

Na podstawie tych czynników, pacjentów można podzielić na kategorie ryzyka:

Niskie ryzyko – Brak czynników ryzyka (0 punktów)
Niskie ryzyko pośrednie – Jeden czynnik ryzyka (1 punkt)
Wysokie ryzyko pośrednie – Dwa czynniki ryzyka (2 punkty)
Wysokie ryzyko – Wszystkie trzy czynniki ryzyka (3 punkty)

¹²

Ogólne ryzyko progresji MGUS do szpiczaka i innych zaburzeń limfoproliferacyjnych wynosi 1% rocznie. U młodych pacjentów z MGUS (poniżej 40 roku życia), ryzyko progresji jest podobne jak u starszych pacjentów i wynosi 1,4% rocznie. Ryzyko progresji do szpiczaka mnogiego lub pokrewnego zaburzenia po 5 latach i 10 latach wynosi odpowiednio 6,0% i 13,8%.¹²

Postępowanie i monitorowanie

MGUS samo w sobie nie wymaga leczenia. Głównym celem postępowania jest regularne monitorowanie w celu wczesnego wykrycia progresji do bardziej zaawansowanej choroby. Podejście to jest często określane jako „aktywne monitorowanie” lub „watch and wait” (obserwacja i oczekiwanie).¹²

Harmonogram wizyt kontrolnych

Wszyscy pacjenci powinni zostać ponownie ocenieni 6 miesięcy po wykryciu białka M, z wykonaniem badań laboratoryjnych (pełna morfologia krwi, kreatynina w surowicy, poziom wapnia w surowicy, elektroforeza białek surowicy i wolne łańcuchy lekkie w surowicy). Dalsze wizyty kontrolne zależą od kategorii ryzyka:¹²

Niskie ryzyko MGUS – Pacjenci ze stabilnym poziomem białka M mogą być kontrolowani co 2-3 lata
Pośrednie ryzyko MGUS – Zalecana jest coroczna kontrola
Wysokie ryzyko MGUS – Zalecana jest coroczna kontrola z możliwością częstszych wizyt w zależności od dynamiki zmian

¹²³

Badania sugerują, że ryzyko progresji MGUS może zmieniać się w czasie. Odkrycia, że MGUS o niskim i pośrednim ryzyku może przekształcić się w MGUS o wysokim ryzyku w ciągu kilku lat, wspierają coroczne badania krwi dla wszystkich osób z rozpoznaniem MGUS lub MGUS łańcuchów lekkich, a także coroczną ocenę klinicznego statusu ryzyka pacjenta.¹

Skierowanie do hematologa

Skierowanie do hematologa jest wskazane w przypadku:¹

Pacjentów z pośrednim i wysokim ryzykiem MGUS
Pacjentów z nieprawidłowymi stosunkami wolnych łańcuchów lekkich
Pacjentów wykazujących oznaki złośliwej progresji
Pacjentów z objawami, które mogą być związane z MGUS (np. neuropatia, niewydolność nerek)

¹²

Pacjenci z MGUS o niskim ryzyku, którzy nie wykazują klinicznych lub laboratoryjnych oznak szpiczaka lub pokrewnych zaburzeń, mogą być nadal monitorowani przez lekarza podstawowej opieki zdrowotnej.¹

Postępowanie w specyficznych sytuacjach

Zdrowie kości

Pacjenci z MGUS mają zwiększone ryzyko złamań, szczególnie złamań osiowych (czaszka, kręgosłup/miednica, mostek/żebra) w porównaniu ze złamaniami dystalnymi (ramię i noga). Międzynarodowa Grupa Robocza ds. Szpiczaka zaleca stosowanie bisfosfonianów we wszystkich przypadkach gammapatii monoklonalnej z osteopenią lub osteoporozą.¹²

Pacjenci z MGUS i związaną z tym utratą masy kostnej (osteopenia lub osteoporoza) mogą odnieść korzyści z leczenia dożylnymi bisfosfonianami, ale rzadziej niż comiesięczne leczenie zwykle wymagane w leczeniu pacjentów ze szpiczakiem mnogim.¹

Infekcje

Badania wykazały, że pacjenci z MGUS mają 2-krotnie zwiększone ryzyko (P≤0.05) rozwinięcia jakiejkolwiek infekcji. Ryzyko dotyczy zarówno infekcji bakteryjnych, jak i wirusowych, w tym zapalenia płuc, zapalenia szpiku kostnego, posocznicy, odmiedniczkowego zapalenia nerek, zapalenia tkanki łącznej, zapalenia wsierdzia, zapalenia opon mózgowych, grypy i półpaśca.¹

Ochrona pacjentów z obniżoną odpornością przed chorobami zakaźnymi, którym można zapobiec szczepieniami, jest okazją do zapobiegania zachorowalności i być może śmiertelności, która jest często pomijana. Dlatego ważne jest, aby pamiętać o rutynowych szczepieniach przeciwko powszechnym chorobom zakaźnym podczas rutynowej opieki kontrolnej.¹

Problemy nerkowe

Gammapatia monoklonalna w kontekście niewyjaśnionego białkomoczu i/lub pogarszającej się funkcji nerek wymaga biopsji nerki w celu postawienia diagnozy. Ważne jest ustalenie źródła produkcji białka monoklonalnego poprzez wykonanie biopsji szpiku kostnego i zaawansowanych badań obrazowych, ponieważ mogą to być klony komórek plazmatycznych lub komórek B.¹

Leczenie koncentruje się na celowaniu w komórki klonalne, aby zatrzymać produkcję białka monoklonalnego, z celem zachowania funkcji nerek. W przypadku braku strategii blokowania odkładania się patogennego białka, głównym celem terapeutycznym jest podstawowy klon komórek B, który je wydziela.¹²

Wpływ psychologiczny diagnozy MGUS

Diagnoza MGUS może wiązać się ze znaczącym wpływem psychologicznym na pacjenta. W badaniu 246 nowo zdiagnozowanych osób z MGUS lub tlącym się szpiczakiem mnogim (SMM) stwierdzono, że 19% zgłaszało lęk, bez istotnej różnicy między grupami MGUS i SMM (22% vs 17%).¹

Biorąc pod uwagę szkodliwe skutki lęku, ważne jest włączenie oceny psychospołecznej w celu optymalizacji opieki nad pacjentami z MGUS. Badanie podkreśla znaczenie przyjęcia holistycznego podejścia do opieki nad pacjentem, podkreślając potrzebę zajęcia się zarówno medycznymi, jak i psychologicznymi aspektami zarządzania MGUS.¹²

Sugeruje się kompleksową strategię, która obejmuje identyfikację i zarządzanie lękiem jako kluczowym elementem opieki nad pacjentem. Biorąc pod uwagę, że lęk może negatywnie wpływać na samopoczucie i jakość życia pacjentów, pracownicy służby zdrowia powinni priorytetowo traktować kompleksową opiekę, która obejmuje zajmowanie się i zarządzanie lękiem obok medycznych aspektów choroby.¹

Opieka pielęgniarska w MGUS

Pielęgniarki odgrywają kluczową rolę w opiece nad pacjentami z MGUS, koncentrując się na edukacji, wsparciu emocjonalnym, monitorowaniu i koordynacji opieki.¹²

Edukacja pacjenta

Edukacja pacjenta jest kluczowym elementem opieki pielęgniarskiej w MGUS i powinna obejmować:¹²

Wyjaśnienie, czym jest MGUS i jakie jest ryzyko progresji
Podkreślenie znaczenia regularnych wizyt kontrolnych i badań
Informowanie o znakach i objawach, które mogą wskazywać na progresję choroby
Edukację na temat zdrowego stylu życia i dbania o ogólny stan zdrowia
Informacje na temat dostępnych grup wsparcia i zasobów

¹²

Nie można przecenić znaczenia edukowania pacjentów, aby zgłaszali wszelkie nowe niepokojące objawy (np. zmęczenie, neuropatię, utratę wagi, poty nocne, ból kości), ponieważ u niektórych pacjentów może wystąpić progresja do szpiczaka lub innych zaburzeń między wizytami kontrolnymi.¹

Monitorowanie pacjenta

Pielęgniarki powinny aktywnie uczestniczyć w monitorowaniu pacjentów z MGUS poprzez:¹

Zapewnienie regularnego harmonogramu badań kontrolnych
Monitorowanie wyników badań laboratoryjnych
Ocenę występowania objawów, które mogą wskazywać na progresję choroby
Ocenę ogólnego stanu zdrowia pacjenta, w tym zdrowia kości i funkcji nerek
Monitorowanie stanu psychicznego pacjenta i potrzeb wsparcia

¹²

Wsparcie emocjonalne

Diagnoza MGUS może być źródłem niepokoju dla pacjentów. Pielęgniarki mogą zapewnić wsparcie emocjonalne poprzez:¹

Poświęcenie czasu na omówienie obaw pacjenta
Zapewnienie dokładnych informacji, aby złagodzić niepotrzebny lęk
Skierowanie do odpowiednich zasobów wsparcia, takich jak grupy wsparcia lub poradnictwo
Podkreślenie, że większość przypadków MGUS pozostaje stabilna i nigdy nie powoduje problemów
Zachęcanie do pozytywnego nastawienia, przypominając, że ryzyko progresji jest niskie

¹²

Koordynacja opieki

Pielęgniarki odgrywają kluczową rolę w koordynacji opieki interdyscyplinarnej dla pacjentów z MGUS, która może obejmować:¹

Ułatwianie komunikacji między pacjentem a zespołem opieki zdrowotnej
Koordynację wizyt i badań
Zarządzanie skierowaniami do specjalistów, gdy jest to wskazane
Zapewnienie płynnego przejścia opieki, jeśli stan pacjenta ulegnie zmianie
Pełnienie funkcji klinicznej pielęgniarki specjalistycznej (CNS), z którą pacjent może się kontaktować w przypadku obaw lub pytań

¹²

Podsumowanie

Monoklonalna gammapatia o nieokreślonym znaczeniu (MGUS) jest stanem przednowotworowym charakteryzującym się obecnością białka monoklonalnego we krwi. Chociaż sama nie wymaga leczenia, MGUS niesie ze sobą ryzyko progresji do bardziej poważnych chorób hematologicznych, takich jak szpiczak mnogi, amyloidoza łańcuchów lekkich, makroglobulinemia Waldenströma czy chłoniak.¹²

Kluczowe w opiece nad pacjentami z MGUS jest regularne monitorowanie, które umożliwia wczesne wykrycie progresji choroby i szybkie rozpoczęcie leczenia, jeśli jest to konieczne. Stratyfikacja ryzyka pozwala na dostosowanie harmonogramu wizyt kontrolnych do indywidualnych potrzeb pacjenta.¹²

Opieka pielęgniarska odgrywa istotną rolę w kompleksowym zarządzaniu MGUS, obejmując edukację pacjenta, monitorowanie, wsparcie emocjonalne i koordynację opieki. Dlatego ważne jest, aby personel pielęgniarski miał dogłębną wiedzę na temat MGUS, jego potencjalnych powikłań i strategii opieki.¹²

Interdyscyplinarne podejście do opieki nad pacjentami z MGUS, uwzględniające zarówno aspekty medyczne, jak i psychospołeczne, jest niezbędne dla zapewnienia optymalnych wyników klinicznych i jakości życia pacjentów.¹²

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Materiały źródłowe

#1 Monoclonal Gammopathy of Undetermined Significance – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK507880/
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic preneoplastic plasma cell disorder that is characterized by serum M-protein less than 30 g/L, bone marrow clonal plasma cells less than 10 percent, absence of plasma cell myeloma-related end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) and absence of B-cell lymphoma or other diseases known to produce an M-protein. MGUS is generally considered a preneoplastic disorder that does not always progress to overt malignancy. […] This activity describes the pathophysiology, presentation, evaluation, and treatment of monoclonal gammopathy of undetermined significance and highlights the role of the interprofessional team in its management. […] Monoclonal gammopathy of undetermined significance (MGUS) is best managed by an interprofessional team that includes primary care providers, hematologists, medical oncologists, and nurses. There is no specific treatment for these patients, they only need long-term follow-up because of the potential to progress to myeloproliferative disorders and numerous other complications.
#1 Monoclonal gammopathy of undetermined significance | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/what-is-multiple-myeloma/monoclonal-gammopathy-of-undetermined-significance
Monoclonal gammopathy of undetermined significance (MGUS) is a precancerous condition and the most common plasma cell disorder. Precancerous conditions are not yet cancer, but there is a chance these abnormal changes will eventually become cancer or a related condition. This can take months or years. […] MGUS usually develops in people 70 years of age or older. Black men (including men of African ancestry) and people with a family history of MGUS or multiple myeloma have a higher chance of developing MGUS. […] MGUS is usually found when doing routine blood work or if multiple myeloma or Waldenstrom macroglobulinemia is suspected. […] When you are diagnosed with MGUS, you will be closely monitored (watched) by your healthcare team for signs of the disease progressing to multiple myeloma or a related condition. This is called watchful waiting. Other treatment is given when MGUS starts to progress to cancer.
#1 Prognosis of young patients with monoclonal gammopathy of undetermined significance (MGUS) | Blood Cancer Journal
https://www.nature.com/articles/s41408-021-00406-6
Monoclonal gammopathy of undetermined significance (MGUS) is rare in young patients (age 40 years at diagnosis), with a prevalence of 0.3%, representing ~2% of all patients with MGUS. […] We hypothesized that MGUS detected in young patients may be associated with a higher risk of progression. […] Young patients with MGUS have a similar risk of progression as older patients, 1.4% per year. […] Over 50% are diagnosed in the setting of immune-related disorders. […] Patients with immune-related disorders may have a lower risk of progression. […] The risk of progression to multiple myeloma or a related disorder at 5 years and 10 years was 6.0% and 13.8%, respectively. […] The size of M protein was a significant risk factor for progression (HR 4.2, 95% CI 2.27.9). […] The M protein resolved in 36 (14%) patients, with a greater likelihood of resolution in patients with immune-related conditions (RR 1.9, 95% CI 1.023.6).
#1 Diagnosis of monoclonal gammopathy of undetermined significance – UpToDate
https://www.uptodate.com/contents/diagnosis-of-monoclonal-gammopathy-of-undetermined-significance
There are three distinct clinical types of MGUS, each with a risk of progressing through a unique intermediate (more advanced) premalignant stage and then to a malignant plasma cell dyscrasia or lymphoproliferative disorder: Non-IgM MGUS (IgG, IgA, or IgD MGUS) â Non-IgM MGUS is the most common subtype of MGUS and has the potential to progress to smoldering (asymptomatic) multiple myeloma and to symptomatic multiple myeloma. […] IgM MGUS â IgM MGUS accounts for approximately 15 percent of MGUS cases. It is considered separately from the non-IgM MGUS because it has the potential to progress to smoldering WaldenstrÃ¶m macroglobulinemia and to symptomatic WaldenstrÃ¶m macroglobulinemia, and less often to lymphoma or AL amyloidosis. Infrequently, IgM MGUS can progress to IgM multiple myeloma.
#1 Monoclonal Gammopathy of Undetermined Significance (MGUS)
https://my.clevelandclinic.org/health/diseases/17744-monoclonal-gammopathy-of-undetermined-significance-mgus
Monoclonal gammopathy of undetermined significance (MGUS) is a blood disorder that affects plasma cells in your bone marrow. Most of the time, M proteins dont cause issues and most people with MGUS dont have symptoms. Some people with this condition may develop a blood cancer or more serious blood disorder. […] Healthcare providers often discover this condition after taking blood or urine samples as part of a routine physical examination. Rarely, this condition may also become a blood cancer or a more serious blood disorder. Providers typically do blood and urine tests every six to 12 months to look for signs that monoclonal gammopathy of undetermined significance is becoming a more serious medical problem. […] Most people with this condition dont need treatment. While MGUS rarely becomes cancerous, your provider will monitor M protein levels in your blood and urine (pee) every six to 12 months for signs of cancer. Sometimes, people with this condition have an increased risk of bone loss or fracture. If youre at risk, your provider may recommend medications and other steps to improve bone density.
#1 What Is MGUS? – Monoclonal Gammopathy of Undetermined Significance | Roswell Park Comprehensive Cancer Center – Buffalo, NY
https://www.roswellpark.org/cancer/multiple-myeloma/about/mgus
MGUS is caused by monoclonal plasma cells. Monoclonal means we think they all began from the same cell. […] When plasma cells become abnormal, they do not stop multiplying, and they produce antibodies that are not targeted to specific germs, so they are useless in fighting infection. […] MGUS does not usually cause symptoms. However, in rare cases it can cause neuropathy, a type of nerve damage that can cause tingling, numbness or pain, mostly starting in the fingers and arms or toes and legs. […] Some patients with MGUS may also develop renal problems when monoclonal proteins accumulate in the kidney tissue. […] MGUS is not a disease, because most of the time it causes no symptoms, but there is a very low risk that it can progress into a symptom-causing disease. […] Because MGUS does not cause symptoms, and the risk of developing symptoms is low, researchers agree that it does not have to be treated only monitored with follow-up visits every six to 12 months. […] Roswell Parks Palliative Care team can assist patients who experience neuropathy due to MGUS or if it occurs as a side effect of treatment.
#1
https://haematologica.org/article/view/9650
Monoclonal gammopathy of undetermined significance (MGUS) is a common benign precursor condition of multiple myeloma (MM) and related disorders. MGUS is considered asymptomatic but has been shown to be associated with peripheral neuropathy (PN). […] We found PN to be truly associated with MGUS and under-recognized in clinical practice. […] The prevalence of PN was higher in participants with MGUS than controls (6.5% vs. 2.8%). […] These findings indicate that PN is truly associated with MGUS, contradicting previous findings that questioned this. […] In conclusion, in this large population-based study, including 15,351 MGUS individuals and 58,619 matched controls, we found that a significant proportion of individuals with MGUS have clinically evident PN (6.5%) and that PN is truly associated with MGUS. In addition, our findings suggest under-recognition of PN in the real-world care of individuals with MGUS.
#1 Monoclonal gammopathy of undetermined significance
https://www.rcpa.edu.au/Manuals/RCPA-Manual/Clinical-Presentations-and-Diagnoses/M/Monoclonal-gammopathy-of-undetermined-significance
Asymptomatic premalignant plasma cell/lymphoplasmacytic proliferative disorder characterised by a serum monoclonal protein of 30g/L, 10% plasma cells on bone marrow biopsy, without associated end organ dysfunction (hypercalcaemia, lytic skeletal lesions, renal dysfunction, anaemia and hyperviscosity). […] A bone marrow biopsy is indicated if there are abnormalities indicating possible end organ damage, a monoclonal protein size of 15g/L, or a non-IgG paraprotein of any level, or if any end organ damage is detected. Haematology referral is recommended to see if a bone marrow biopsy may be required. […] Patients with MGUS should be observed with clinical review, Full blood count, Electrolytes, Calcium, serum EPG, Immunofixation, Bence Jones protein urine and quantitative immunoglobulins every 3-12 months, depending on the age, risk (based on PP less than/greater than 15g/L, Ig subtype, and free light chain ratio) and level of concern in the individual patient.
#1 Monoclonal gammopathy of undetermined significance: A primary care guide | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/86/1/39
The presence of less than 10% plasma cells in the bone marrow is required to satisfy the definition of MGUS, but bone marrow biopsy can be omitted for patients with low-risk MGUS, given the slim chance of finding a significant percentage of clonal plasma cells in the marrow and the inherently low risk of progression. […] Most experts agree that all patients should be reevaluated 6 months after an M protein is detected, with laboratory surveillance tests (complete blood cell count, serum creatinine, serum calcium level, serum protein electrophoresis, and serum free light chains). Low-risk patients with a stable M protein level can be followed every 2 to 3 years. […] Referral to a hematologist is warranted for patients with intermediate- and high-risk MGUS, patients with abnormal serum free light-chain ratios, and those who show evidence of malignant progression. Patients with intermediate-and high-risk MGUS could be referred for bone marrow biopsy before assessment by a hematologist. The primary care provider may continue to follow patients with low-risk MGUS who do not display clinical or laboratory evidence of myeloma or related disorders.
#1 Monoclonal Gammopathy of Undetermined Significance (MGUS) – Hematology and Oncology – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/monoclonal-gammopathy-of-undetermined-significance-mgus
Monoclonal gammopathy of undetermined significance (MGUS) is the production of M-protein by noncancerous plasma cells in the absence of other manifestations typical of multiple myeloma. […] MGUS usually is asymptomatic, but peripheral neuropathy can occur, and patients are at higher risk of enhanced bone loss and fractures. […] Because of fracture risk, baseline evaluation with a skeletal survey (ie, plain radiographs of the skull, long bones, spine, pelvis, and ribs) and bone densitometry should be done. […] No antineoplastic treatment is recommended. However, patients with MGUS and associated bone loss (osteopenia or osteoporosis) may benefit from treatment with intravenous bisphosphonates but less frequently than the monthly treatments usually required to treat patients with multiple myeloma. […] Every 6 to 12 months, patients should undergo clinical examination and serum and urine protein electrophoresis to evaluate for disease progression.
#1 Monoclonal gammopathy of undetermined significance: A primary care guide – PubMed
https://pubmed.ncbi.nlm.nih.gov/30624183/
Monoclonal gammopathy of undetermined significance (MGUS) is commonly diagnosed in outpatients being worked up for an array of clinical concerns. It carries a risk of progression to myeloma and other lymphoproliferative disorders that, albeit low (1% per year), warrants regular follow-up. Patients with MGUS can be risk-stratified on the basis of the amount and type of their monoclonal protein as well as whether they have an abnormal light-chain ratio. Here, we provide a guide to the diagnosis, workup, and management of MGUS.
#1 Monoclonal Gammopathy of Undetermined Significance (MGUS) â
https://watch.giblib.com/video/10267
If you were to just break down and say risk factors, someone could come up with the and letâs split them by what is host dependent and what is environmental. […] Thereâs an increased risk of developing an MGUS with age. […] The other key factors are race. […] Family history has been a big one, so first-degree relatives of patients with MGUS or myeloma have roughly a 2 to 3 fold higher risk of developing MGUS than other individuals. […] There is no strong data to support any form of pharmacologic or dietary or even lifestyle change that could prevent the progression of MGUS. […] If you have none of those, you have zero points. You are in the low-risk MGUS category. […] If you have one of those, then youâre in the low intermediate risk. […] If you have two of those factors, youâre in the high intermediate risk.
#1 Monoclonal gammopathy of undetermined significance: A primary care guide | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/86/1/39
Monoclonal gammopathy of undetermined significance (MGUS) is commonly diagnosed in outpatients being worked up for an array of clinical concerns. It carries a risk of progression to myeloma and other lymphoproliferative disorders that, albeit low (1% per year), warrants regular follow-up. Patients with MGUS can be risk-stratified on the basis of the amount and type of their monoclonal protein as well as whether they have an abnormal light-chain ratio. Here, we provide a guide to the diagnosis, workup, and management of MGUS. […] The overall risk of MGUS progressing to myeloma and other lymphoproliferative disorders is 1% per year. […] Low-risk MGUS carries a much lower risk of progression than intermediate- and high-risk MGUS, may not require subspecialty referral, and can be followed by the outpatient provider.
#1 Monoclonal gammopathy of undetermined significance | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/what-is-multiple-myeloma/monoclonal-gammopathy-of-undetermined-significance
Follow-up visits are scheduled differently for low-risk MGUS and high-risk MGUS. […] If you have low-risk MGUS, a follow-up visit is scheduled 6 months after diagnosis. If the disease is stable, follow-ups will be scheduled every 2 to 3 years until you start developing symptoms or signs that the MGUS is progressing. […] If you have high-risk MGUS, a follow-up visit is scheduled 6 months after a diagnosis, then once every year until you start developing symptoms or signs that the MGUS is progressing.
#1 Risk of MGUS Progression to Myeloma Can Change – NCI
https://www.cancer.gov/news-events/cancer-currents-blog/2019/mgus-multiple-myeloma-progression-risk
The findings that low- and intermediate-risk MGUS could convert to high-risk MGUS within a few years, the study authors wrote, supports annual blood testing for all individuals diagnosed with MGUS or light-chain MGUS, as well as yearly assessment of a patients clinical risk status. […] A potential benefit of annual blood testing is that it could lead to earlier detection of multiple myeloma, which could lessen or prevent severe myeloma-related complications like a bone fracture or kidney failure, Dr. Landgren said. […] Drs. Landgren and Hofmann are exploring other markers that may be more predictive of progression to myeloma.
#1 Monoclonal Gammopathies of Undetermined Significance (MGUS): Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/204297-overview
The risk of venous thromboembolism (VTE) is increased in patients with MGUS. […] The risk was significantly higher for axial (skull, vertebral/pelvis, and sternum/costae) compared with distal (arm and leg) fractures. […] Kristinsson et al reported that patients with MGUS had a 2-fold increased risk (P 0.05) of developing any infection. The risk extended to both bacterial and viral infections, and the following specific infections were noted: Pneumonia, Osteomyelitis, Septicemia, Pyelonephritis, Cellulitis, Endocarditis, Meningitis, Influenza, Herpes zoster.
#1 Monoclonal Gammopathy of Undetermined Significance (MGUS)âNot So Asymptomatic after All
https://www.mdpi.com/2072-6694/12/6/1554
The use of bisphosphonates in patients with MGUS with reduced bone mineral density is associated with a reduced risk of fractures. […] In the absence of strategies to block the deposition of the pathogenic protein, the principal therapeutic target is the underlying B-cell clone that secretes it. Treatment options usually involve the use of chemotherapies (melphalan, cyclophosphamide, and bendamustine), dexamethasone, bortezomib, or immunotherapies like rituximab, employed with the goal of preserving renal function and targeting the clonal population of cells that are producing the monoclonal immunoglobulin. […] The majority of patients with MGUS are over the age of 65, and even in healthy individuals, the immune response to vaccination declines with age. […] Protecting immunocompromised patients against vaccine-preventable infectious disease is an opportunity to prevent morbidity and perhaps mortality that is frequently missed. The current standard of care for patients with MGUS or SMM is observation, and during this time, it is important to remember routine vaccination against common infectious diseases during routine follow-up care, so-called âwatch, wait, and vaccinateâ.
#1 Cracking the âMGUSâ Code Reveals Monoclonal Gammopathy of Clinical Significance:
https://www.onclive.com/view/cracking-the-mgus-code-reveals-monoclonal-gammopathy-of-clinical-significance-
When assessing monoclonal gammopathy it is important to rule out clinically significant associations requiring treatment. […] It is critical to recall that monoclonal proteins can be produced by both plasma cells and B cells, and identifying the source will determine the treatment in many cases. A referral to a center with multidisciplinary care is best practice to ensure appropriate workup in a timely manner. […] Monoclonal gammopathy in the setting of unexplained proteinuria and/or declining renal function requires renal biopsy for diagnosis. It is important to elicit the source of monoclonal protein production by obtaining a bone marrow biopsy and advanced imaging as these can be either plasma cell or B-cell clones. […] Treatment is focused on targeting the clonal cells to stop the monoclonal protein production with the goal of preserving renal function.
#1 Psychological Impact in Individuals with Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma | Published in Clinical Hematology International
https://chi.scholasticahq.com/article/123608-psychological-impact-in-individuals-with-monoclonal-gammopathy-of-undetermined-significance-and-smoldering-multiple-myeloma
In our study of 246 newly diagnosed individuals with MGUS or SMM (115 MGUS, 131 SMM), we found that 19% reported anxiety, with no significant difference between the MGUS and SMM groups (22% vs. 17%). […] Given anxiety’s detrimental effects, our findings emphasize the importance of incorporating psychosocial assessments to optimize care for MGUS and SMM patients. […] The diagnosis of MGUS and/or SMM may be linked to psychological effects that can have a detrimental impact on patients’ quality of life (QoL). […] Our study aimed to evaluate the prevalence of adverse psychosocial effects among individuals with newly diagnosed MGUS and/or SMM. […] Our study found that one third of patients referred with diagnosis of MGUS or SMM has history of psychiatric disorder. This indicates that pre-existing mental health conditions may significantly influence the psychological response of patients upon receiving a diagnosis of MGUS or SMM.
#1 Psychological Impact in Individuals with Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma | Published in Clinical Hematology International
https://chi.scholasticahq.com/article/123608-psychological-impact-in-individuals-with-monoclonal-gammopathy-of-undetermined-significance-and-smoldering-multiple-myeloma
The study underscores the importance of adopting a holistic approach to patient care, highlighting the need to address both the medical and psychological dimensions of managing MGUS and SMM. […] We suggest a comprehensive strategy that includes the identification and management of anxiety as a critical component of patient care. […] Given that anxiety can negatively affect patients’ well-being and quality of life, healthcare providers should prioritize comprehensive care that includes addressing and managing anxiety alongside the medical aspects of the disease. […] Furthermore, conducting anxiety assessments for patients prior to their oncologist appointments can be advantageous.
#1 Ask the Nurse: monoclonal gammopathy of undetermined significance (MGUS) – Myeloma UK
https://www.myeloma.org.uk/library/ask-the-nurse-mgus/
For most patients, a diagnosis of monoclonal gammopathy of undetermined significance (MGUS) does not affect their daily life. However, it can be concerning to receive a diagnosis for which there is no treatment, that requires regular monitoring, and has a very small possibility of developing into another condition. […] Most MGUS patients have a stable condition that does not affect their general health. […] As an MGUS patient, you will have regular check-ups and blood tests because a very small proportion of patients will develop a more serious condition, such as myeloma, AL amyloidosis or lymphoma. […] Typically, MGUS is actively monitored with blood tests but not treated. MGUS patients are usually checked 3â6 months after diagnosis. The checks are then usually reduced to every 12 months as long as no symptoms develop.
#1 Risk Stratifying Patients with Monoclonal Gammopathy of Undetermined Significance
https://consultqd.clevelandclinic.org/risk-stratifying-patients-with-monoclonal-gammopathy-of-undetermined-significance
After MGUS is confirmed, the patient should be risk-stratified to determine the need for bone marrow biopsy and to predict the risk of progression to more serious conditions. […] The importance of educating patients to report any new worrisome symptom (e.g., fatigue, neuropathy, weight loss, night sweats, bone pain) cannot be overemphasized, as some patients may progress to myeloma or other disorders between follow-up visits.
#1 CE Activity | Monoclonal Gammopathy of Undetermined Significance | Nurses
https://www.statpearls.com/nurse/ce/activity/40192
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic preneoplastic plasma cell disorder that is characterized by serum M-protein less than 30 g/L, bone marrow clonal plasma cells less than 10 percent, absence of plasma cell myeloma-related end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) and absence of B-cell lymphoma or other diseases known to produce an M-protein. MGUS is generally considered a preneoplastic disorder that does not always progress to overt malignancy. […] This activity describes the pathophysiology, presentation, evaluation, and treatment of monoclonal gammopathy of undetermined significance and highlights the role of the interprofessional team in its management. […] At the conclusion of this activity, the learner will be better able to:
#1 Ask the Nurse: monoclonal gammopathy of undetermined significance (MGUS) – Myeloma UK
https://www.myeloma.org.uk/library/ask-the-nurse-mgus/
If you experience new symptoms such as pain, particularly in your back or ribs, fatigue, and recurring infections, you should tell your doctor or nurse as soon as possible (within two weeks). You should not wait until their next appointment to tell them. […] Currently, there are no specific treatments to stop MGUS from progressing. However, this is a focus area for our research. […] Unfortunately, doctors do not know why some people with MGUS develop cancer, and others do not. […] Talk to your doctor or nurse about your concerns. They can explain more about your condition and risk and arrange counselling for you if needed.
#1 MGUS (monoclonal gammopathy of undetermined significance) – Recent diagnosis – Blood Cancer UK Online Community Forum
https://forum.bloodcancer.org.uk/t/mgus-monoclonal-gammopathy-of-undetermined-significance/1437
I do not have any experience or knowledge of MGUS, but it does sound as if you could do with some advice from your GP or possibly your haematologist, especially as your haematologist appointment is a few months away. […] Its really good that you have kept an eye on any new symptoms youve been experiencing. […] I have wrote things down for appointments too in the past but im always embarrassed to bring the paper out, I feel like a hypochondriac which truth be told I am. […] Its understandable to have concerns if you find you are experiencing any new symptoms, and we do encourage and advise people to seek support and advice in situations like this.
#1 MGUS (monoclonal gammopathy of undetermined significance) – Recent diagnosis – Blood Cancer UK Online Community Forum
https://forum.bloodcancer.org.uk/t/mgus-monoclonal-gammopathy-of-undetermined-significance/1437
Hello, I thought as MGUS is a commonly searched phrase on the forum that it would make sense for those recently diagnosed with MGUS/living with MGUS as while there over 4000 diagnoses every year, people can feel alone living with it and the worry that follows as a small percentage each year will go on to develop a blood cancer such as myeloma or lymphoma. […] I think firstly its really important for you to feel you understand MGUS, what it is and what happens next. […] Its important to remember that should your mgus ever transform in myeloma, which is far from certain, you will be in the era of groundbreaking treatments and should remain positive. […] I was also told that MGUS is symptomless but I have constant pain in my arms and legs and also my hips and back. […] I hope you have been allocated a Clinical Nurse Specialist who you can contact if you have any concerns or questions.
#2 Monoclonal Gammopathy of Undetermined Significance (MGUS)
https://my.clevelandclinic.org/health/diseases/17744-monoclonal-gammopathy-of-undetermined-significance-mgus
Monoclonal gammopathy of undetermined significance (MGUS) is a blood disorder that affects plasma cells in your bone marrow. Most of the time, M proteins dont cause issues and most people with MGUS dont have symptoms. Some people with this condition may develop a blood cancer or more serious blood disorder. […] Healthcare providers often discover this condition after taking blood or urine samples as part of a routine physical examination. Rarely, this condition may also become a blood cancer or a more serious blood disorder. Providers typically do blood and urine tests every six to 12 months to look for signs that monoclonal gammopathy of undetermined significance is becoming a more serious medical problem. […] Most people with this condition dont need treatment. While MGUS rarely becomes cancerous, your provider will monitor M protein levels in your blood and urine (pee) every six to 12 months for signs of cancer. Sometimes, people with this condition have an increased risk of bone loss or fracture. If youre at risk, your provider may recommend medications and other steps to improve bone density.
#2 Monoclonal gammopathy of undetermined significance (MGUS) – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/mgus/diagnosis-treatment/drc-20352367
Because MGUS usually causes no symptoms, people who have it usually find out by chance during blood tests for other reasons. […] Our caring team of Mayo Clinic experts can help you with your Monoclonal gammopathy of undetermined significance (MGUS)-related health concerns Start Here […] MGUS doesn’t require treatment. But your health care provider is likely to have you get regular checkups to watch the condition. Checkups likely will start six months after your diagnosis. […] For those at high risk of MGUS leading to a more serious condition, more-frequent checkups can watch the disease. That way, treatment can start as soon as possible if it’s needed. […] Connect with others like you for support and answers to your questions in the Blood Cancers Disorders support group on Mayo Clinic Connect, a patient community.
#2 Diagnosis of monoclonal gammopathy of undetermined significance – UpToDate
https://www.uptodate.com/contents/diagnosis-of-monoclonal-gammopathy-of-undetermined-significance
Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic premalignant clonal plasma cell or lymphoplasmacytic proliferative disorder. It is defined by the presence of a serum monoclonal protein (M protein) at a concentration <3 g/dL, a bone marrow with <10 percent monoclonal plasma cells, and absence of end-organ damage (lytic bone lesions, anemia, hypercalcemia, kidney impairment, hyperviscosity) related to the proliferative process. [...] MGUS occurs in over 3 percent of the White population over the age of 50 and is typically detected as an incidental finding when individuals undergo a protein electrophoresis as part of an evaluation for a wide variety of clinical symptoms and disorders (eg, peripheral neuropathy, vasculitis, hemolytic anemia, skin rashes, hypercalcemia, or elevated erythrocyte sedimentation rate).
#2 Monoclonal Gammopathy of Undetermined Significance (MGUS)âNot So Asymptomatic after All
https://www.mdpi.com/2072-6694/12/6/1554
Monoclonal Gammopathy of Undetermined Significance (MGUS) is considered to be a benign precursor condition that may progress to a lymphoproliferative disease or multiple myeloma. Most patients do not progress to an overt condition, but nevertheless, MGUS is associated with a shortened life expectancy and, in a minority of cases, a number of co-morbid conditions that include an increased fracture risk, renal impairment, peripheral neuropathy, secondary immunodeficiency, and cardiovascular disease. […] The aim of this review is to examine the most consistently reported co-morbidities associated with MGUS, namely the increased risk of bone fractures, peripheral neuropathy, renal impairment, secondary immunodeficiency, and cardiovascular disease. […] The occurrence of a non-traumatic fracture in the context of MGUS requires careful assessment by a hematologist with access to cross-sectional imaging and a bone marrow biopsy to exclude a myeloma-defining event.
#2 Making Sense of MGUS: How to Detect Plasma Cell Disorders and Assess Associated Risks – UCSF MedConnection
https://medconnection.ucsfhealth.org/videos/making-sense-of-mgus-how-to-detect-plasma-cell-disorders-and-assess-associated-risks
Affecting up to 5% of the U.S. population (and increasingly common with age), monoclonal gammopathy of undetermined significance (MGUS) raises the risk of multiple myeloma, but as its full name suggests it can be hard to say by how much. […] MGUS carries about a 1% per year likelihood of progression to myeloma. […] The majority of patients do not ultimately develop cancer, so I think it’s important when you’ve made that diagnosis that you counsel them accordingly so it doesn’t lead to, um, obviously a lot of stress um when they hear the word pre-cancer or um precursor lesion to cancer. […] To diagnose an MGUS, you need to have a serum and protein, so that’s that monoclonal and protein on the SPAP, of less than 3 g per deciliter. […] And also, uh, and more importantly, you should have no myeloma defining events, which is that slim crab criteria. […] So in my practice, if I feel like someone’s quite low risk, I will ask the primary care, do you feel comfortable getting these labs in 1 year, in 2 years, etc. and sending them back to me if anything comes back abnormal.
#2 Monoclonal gammopathy of undetermined significance: A primary care guide | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/86/1/39
The presence of less than 10% plasma cells in the bone marrow is required to satisfy the definition of MGUS, but bone marrow biopsy can be omitted for patients with low-risk MGUS, given the slim chance of finding a significant percentage of clonal plasma cells in the marrow and the inherently low risk of progression. […] Most experts agree that all patients should be reevaluated 6 months after an M protein is detected, with laboratory surveillance tests (complete blood cell count, serum creatinine, serum calcium level, serum protein electrophoresis, and serum free light chains). Low-risk patients with a stable M protein level can be followed every 2 to 3 years. […] Referral to a hematologist is warranted for patients with intermediate- and high-risk MGUS, patients with abnormal serum free light-chain ratios, and those who show evidence of malignant progression. Patients with intermediate-and high-risk MGUS could be referred for bone marrow biopsy before assessment by a hematologist. The primary care provider may continue to follow patients with low-risk MGUS who do not display clinical or laboratory evidence of myeloma or related disorders.
#2 Monoclonal gammopathy of undetermined significance
https://www.rcpa.edu.au/Manuals/RCPA-Manual/Clinical-Presentations-and-Diagnoses/M/Monoclonal-gammopathy-of-undetermined-significance
Asymptomatic premalignant plasma cell/lymphoplasmacytic proliferative disorder characterised by a serum monoclonal protein of 30g/L, 10% plasma cells on bone marrow biopsy, without associated end organ dysfunction (hypercalcaemia, lytic skeletal lesions, renal dysfunction, anaemia and hyperviscosity). […] A bone marrow biopsy is indicated if there are abnormalities indicating possible end organ damage, a monoclonal protein size of 15g/L, or a non-IgG paraprotein of any level, or if any end organ damage is detected. Haematology referral is recommended to see if a bone marrow biopsy may be required. […] Patients with MGUS should be observed with clinical review, Full blood count, Electrolytes, Calcium, serum EPG, Immunofixation, Bence Jones protein urine and quantitative immunoglobulins every 3-12 months, depending on the age, risk (based on PP less than/greater than 15g/L, Ig subtype, and free light chain ratio) and level of concern in the individual patient.
#2 Monoclonal Gammopathy of Undetermined Significance (MGUS) â
https://watch.giblib.com/video/10267
If you have all three of those factors, then youâre in the high risk. […] If somebody is clearly a high intermediate risk, high risk and even low intermediate risk after one evaluates a patient, clearly, imaging can be ordered for them. […] If youâre in that low-risk MGUS group, you really donât need the cross-sectional imaging, you really donât need the bone marrow exam. […] If youâre not in that low risk, yes, you really after that initial six-month check, you should be checking it yearly because over a lifetime there is a significant risk of progression.
#2 Monoclonal Gammopathy of Undetermined Significance (MGUS) â
https://watch.giblib.com/video/10267
If you were to just break down and say risk factors, someone could come up with the and letâs split them by what is host dependent and what is environmental. […] Thereâs an increased risk of developing an MGUS with age. […] The other key factors are race. […] Family history has been a big one, so first-degree relatives of patients with MGUS or myeloma have roughly a 2 to 3 fold higher risk of developing MGUS than other individuals. […] There is no strong data to support any form of pharmacologic or dietary or even lifestyle change that could prevent the progression of MGUS. […] If you have none of those, you have zero points. You are in the low-risk MGUS category. […] If you have one of those, then youâre in the low intermediate risk. […] If you have two of those factors, youâre in the high intermediate risk.
#2 Prognosis of young patients with monoclonal gammopathy of undetermined significance (MGUS) | Blood Cancer Journal
https://www.nature.com/articles/s41408-021-00406-6
Monoclonal gammopathy of undetermined significance (MGUS) is rare in young patients (age 40 years at diagnosis), with a prevalence of 0.3%, representing ~2% of all patients with MGUS. […] We hypothesized that MGUS detected in young patients may be associated with a higher risk of progression. […] Young patients with MGUS have a similar risk of progression as older patients, 1.4% per year. […] Over 50% are diagnosed in the setting of immune-related disorders. […] Patients with immune-related disorders may have a lower risk of progression. […] The risk of progression to multiple myeloma or a related disorder at 5 years and 10 years was 6.0% and 13.8%, respectively. […] The size of M protein was a significant risk factor for progression (HR 4.2, 95% CI 2.27.9). […] The M protein resolved in 36 (14%) patients, with a greater likelihood of resolution in patients with immune-related conditions (RR 1.9, 95% CI 1.023.6).
#2 Myeloma – Leukaemia Foundation
https://www.leukaemia.org.au/blood-cancer/types-of-blood-cancer/myeloma/mgus/
Monoclonal gammopathy of undetermined significance (MGUS) is a disorder of the plasma cells. People with MGUS produce an abnormal protein called an M-protein rather than antibodies. The M-protein can build up in your blood stream and urine. The M-protein reduces your bodyâs ability to fight infection. MGUS doesnât require any treatment, but monitoring is recommended. About 20% of people with MGUS develop myeloma. […] Active monitoring (watch and wait) involves regular blood tests and general health checks. No intervention is needed unless you develop signs and symptoms to suggest the myeloma is progressing. People with smouldering myeloma and MGUS are generally actively monitored.
#2 Risk Stratifying Patients with Monoclonal Gammopathy of Undetermined Significance
https://consultqd.clevelandclinic.org/risk-stratifying-patients-with-monoclonal-gammopathy-of-undetermined-significance
The monoclonal gammopathies encompass a number of disorders characterized by the production of a monoclonal protein (M protein) by an abnormal clone of plasma cells or other lymphoid cells. Monoclonal gammopathy of undetermined significance (MGUS) is the most common of these disorders. Its clinical relevance lies in the inherent risk of progression to hematologic malignancies such as multiple myeloma or other lymphoproliferative disorders, or of organ dysfunction due to the toxic effects of the M protein. […] Most of the recommendations regarding follow-up are based on expert opinion, given the lack of randomized data. Most experts agree that all patients should be reevaluated six months after an M protein is detected, with laboratory surveillance tests (complete blood cell count, serum creatinine, serum calcium level, serum protein electrophoresis and serum free light chains). Low-risk patients with a stable M protein level can be followed every two to three years.
#2 What is MGUS and Why Is It Important to Monitor for It?
https://blog.virginiacancer.com/what-is-mgus-and-why-is-it-important-to-monitor-for-it
If watchful waiting shows MGUS is progressing, you may receive treatment from one or more of the following types of physicians: a nephrologist (renal/kidney specialist), a neurologist (brain/spine and nerve specialist), and/or a hematologist (blood and bone marrow specialist). […] If you have been diagnosed with MGUS, be sure you have a regular check-up plan in place with a specialist such as a hematologist.
#2 Cracking the âMGUSâ Code Reveals Monoclonal Gammopathy of Clinical Significance:
https://www.onclive.com/view/cracking-the-mgus-code-reveals-monoclonal-gammopathy-of-clinical-significance-
The International Myeloma Working Group recommends bisphosphonate use in all cases of monoclonal gammopathy with osteopenia or osteoporosis. […] Even small plasma cell or B-cell clones can alter the bone marrow environment and immune response leading to different acquired hematologic disorders. […] Treatment is a combination of plasma celldirected therapy and immunosuppression.
#2 Monoclonal Gammopathy of Undetermined Significance (MGUS)âNot So Asymptomatic after All
https://www.mdpi.com/2072-6694/12/6/1554
The use of bisphosphonates in patients with MGUS with reduced bone mineral density is associated with a reduced risk of fractures. […] In the absence of strategies to block the deposition of the pathogenic protein, the principal therapeutic target is the underlying B-cell clone that secretes it. Treatment options usually involve the use of chemotherapies (melphalan, cyclophosphamide, and bendamustine), dexamethasone, bortezomib, or immunotherapies like rituximab, employed with the goal of preserving renal function and targeting the clonal population of cells that are producing the monoclonal immunoglobulin. […] The majority of patients with MGUS are over the age of 65, and even in healthy individuals, the immune response to vaccination declines with age. […] Protecting immunocompromised patients against vaccine-preventable infectious disease is an opportunity to prevent morbidity and perhaps mortality that is frequently missed. The current standard of care for patients with MGUS or SMM is observation, and during this time, it is important to remember routine vaccination against common infectious diseases during routine follow-up care, so-called âwatch, wait, and vaccinateâ.
#2 Psychological Impact in Individuals with Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma | Published in Clinical Hematology International
https://chi.scholasticahq.com/article/123608-psychological-impact-in-individuals-with-monoclonal-gammopathy-of-undetermined-significance-and-smoldering-multiple-myeloma
The study underscores the importance of adopting a holistic approach to patient care, highlighting the need to address both the medical and psychological dimensions of managing MGUS and SMM. […] We suggest a comprehensive strategy that includes the identification and management of anxiety as a critical component of patient care. […] Given that anxiety can negatively affect patients’ well-being and quality of life, healthcare providers should prioritize comprehensive care that includes addressing and managing anxiety alongside the medical aspects of the disease. […] Furthermore, conducting anxiety assessments for patients prior to their oncologist appointments can be advantageous.
#2 CE Activity | Monoclonal Gammopathy of Undetermined Significance | Nurses
https://www.statpearls.com/nurse/ce/activity/40192
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic preneoplastic plasma cell disorder that is characterized by serum M-protein less than 30 g/L, bone marrow clonal plasma cells less than 10 percent, absence of plasma cell myeloma-related end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) and absence of B-cell lymphoma or other diseases known to produce an M-protein. MGUS is generally considered a preneoplastic disorder that does not always progress to overt malignancy. […] This activity describes the pathophysiology, presentation, evaluation, and treatment of monoclonal gammopathy of undetermined significance and highlights the role of the interprofessional team in its management. […] At the conclusion of this activity, the learner will be better able to:
#2 Risk Stratifying Patients with Monoclonal Gammopathy of Undetermined Significance
https://consultqd.clevelandclinic.org/risk-stratifying-patients-with-monoclonal-gammopathy-of-undetermined-significance
After MGUS is confirmed, the patient should be risk-stratified to determine the need for bone marrow biopsy and to predict the risk of progression to more serious conditions. […] The importance of educating patients to report any new worrisome symptom (e.g., fatigue, neuropathy, weight loss, night sweats, bone pain) cannot be overemphasized, as some patients may progress to myeloma or other disorders between follow-up visits.
#2 Ask the Nurse: monoclonal gammopathy of undetermined significance (MGUS) – Myeloma UK
https://www.myeloma.org.uk/library/ask-the-nurse-mgus/
If you experience new symptoms such as pain, particularly in your back or ribs, fatigue, and recurring infections, you should tell your doctor or nurse as soon as possible (within two weeks). You should not wait until their next appointment to tell them. […] Currently, there are no specific treatments to stop MGUS from progressing. However, this is a focus area for our research. […] Unfortunately, doctors do not know why some people with MGUS develop cancer, and others do not. […] Talk to your doctor or nurse about your concerns. They can explain more about your condition and risk and arrange counselling for you if needed.
#2 Monoclonal Gammopathy of Undetermined Significance – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK507880/
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic preneoplastic plasma cell disorder that is characterized by serum M-protein less than 30 g/L, bone marrow clonal plasma cells less than 10 percent, absence of plasma cell myeloma-related end-organ damage (hypercalcemia, renal insufficiency, anemia, or bone lesions) and absence of B-cell lymphoma or other diseases known to produce an M-protein. MGUS is generally considered a preneoplastic disorder that does not always progress to overt malignancy. […] This activity describes the pathophysiology, presentation, evaluation, and treatment of monoclonal gammopathy of undetermined significance and highlights the role of the interprofessional team in its management. […] Monoclonal gammopathy of undetermined significance (MGUS) is best managed by an interprofessional team that includes primary care providers, hematologists, medical oncologists, and nurses. There is no specific treatment for these patients, they only need long-term follow-up because of the potential to progress to myeloproliferative disorders and numerous other complications.
#3 Monoclonal Gammopathy of Undetermined Significance (MGUS) – Hematology and Oncology – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/monoclonal-gammopathy-of-undetermined-significance-mgus
Monoclonal gammopathy of undetermined significance (MGUS) is the production of M-protein by noncancerous plasma cells in the absence of other manifestations typical of multiple myeloma. […] MGUS usually is asymptomatic, but peripheral neuropathy can occur, and patients are at higher risk of enhanced bone loss and fractures. […] Because of fracture risk, baseline evaluation with a skeletal survey (ie, plain radiographs of the skull, long bones, spine, pelvis, and ribs) and bone densitometry should be done. […] No antineoplastic treatment is recommended. However, patients with MGUS and associated bone loss (osteopenia or osteoporosis) may benefit from treatment with intravenous bisphosphonates but less frequently than the monthly treatments usually required to treat patients with multiple myeloma. […] Every 6 to 12 months, patients should undergo clinical examination and serum and urine protein electrophoresis to evaluate for disease progression.
#3 Risk Stratifying Patients with Monoclonal Gammopathy of Undetermined Significance
https://consultqd.clevelandclinic.org/risk-stratifying-patients-with-monoclonal-gammopathy-of-undetermined-significance
The monoclonal gammopathies encompass a number of disorders characterized by the production of a monoclonal protein (M protein) by an abnormal clone of plasma cells or other lymphoid cells. Monoclonal gammopathy of undetermined significance (MGUS) is the most common of these disorders. Its clinical relevance lies in the inherent risk of progression to hematologic malignancies such as multiple myeloma or other lymphoproliferative disorders, or of organ dysfunction due to the toxic effects of the M protein. […] Most of the recommendations regarding follow-up are based on expert opinion, given the lack of randomized data. Most experts agree that all patients should be reevaluated six months after an M protein is detected, with laboratory surveillance tests (complete blood cell count, serum creatinine, serum calcium level, serum protein electrophoresis and serum free light chains). Low-risk patients with a stable M protein level can be followed every two to three years.