Management of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).
ABSTRACT Monoclonal gammopathy of undetermined significance (MGUS) is defined as a serum M protein level of less than 3 g/dL, less than 10% clonal plasma cells in the bone marrow, and the absence of end-organ damage. The prevalence of MGUS is 3.2% in the white population but is approximately twice that high in the black population. MGUS may progress to multiple myeloma, AL amyloidosis, Waldenström macroglobulinemia, or lymphoma. The risk of progression is approximately 1% per year, but the risk continues even after more than 25 years of observation. Risk factors for progression include the size of the serum M protein, the type of serum M protein, the number of plasma cells in the bone marrow, and the serum free light chain ratio. Smoldering (asymptomatic) multiple myeloma (SMM) is characterized by the presence of an M protein level of 3 g/dL or higher and/or 10% or more monoclonal plasma cells in the bone marrow but no evidence of end-organ damage. The overall risk of progression to a malignant condition is 10% per year for the first 5 years, approximately 3% per year for the next 5 years, and 1% to 2% per year for the following 10 years. Patients with both MGUS and SMM must be followed up for their lifetime.
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ABSTRACT: This article continues a series on literature-based followup recommendations for conditions commonly encountered in general oncology practice. The accidental discovery of a monoclonal gammopathy (monoclonal protein or M protein, M spike) becomes increasingly common with advanced patient age, affecting approximately 3% to 4% of those over age 50, 5% over age 65 and almost 10% of those 85 or older. Since adult oncology practice is largely concerned with individuals 60 years and older, all oncologists require some familiarity with the investigation, natural history, followup and timing of subspecialist referral of patients with monoclonal gammopathy of undetermined significance (MGUS). Earlier studies suggest that in over 50% of patients in whom an M protein was accidentally detected, no subsequent followup was actually undertaken.5 In order to facilitate an orderly approach, this article utilizes a question-based format to address the most common concerns that arise when oncologists are confronted with a monoclonal protein. Virtually no randomized data exist on this topic, so references are primarily literature-based consensus guidelines and recommendations. Key words MGUS, monoclonal gammopathy, M spike, M protein, Waldenström macroglobulinemia, multiple myeloma, smouldering multiple myeloma, systemic amyloidosisOncology Exchange. 08/2013; 12(No. 3):15-20.
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ABSTRACT: Oncology nurses working in ambulatory care often encounter patients with nonmalignant hematologic disorders because the specialties of hematology and oncology are closely entwined. A variety of nonmalignant hematologic disorders can evolve into blood malignancies; therefore, close surveillance of nonmalignant hematologic disorders in an oncology/hematology clinic is important for early detection of malignancy. Monoclonal gammopathy of undetermined significance (MGUS) is one nonmalignant, hematologic disorder that is usually aproblematic; however, it can evolve into a blood malignancy such as multiple myeloma or be associated with other chronic conditions. This article provides an overview of MGUS with a focus on implications for the oncology nurse and patient education.Clinical Journal of Oncology Nursing 12/2013; 17(6):614-9.
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ABSTRACT: During the last two decades, many steps forward have been made in the treatment of multiple myeloma (MM) thanks to the introduction of the novel agents thalidomide, lenalidomide, and bortezomib. Despite this, MM remains an incurable disease. Elderly patients (≥65 years) represent the majority of subjects. Differently from younger (<65 years) and fit patients, elderly patients are usually not eligible for transplantation. Gentler approaches with novel agents plus conventional chemotherapy with melphalan-prednisone are commonly adopted in this setting. Data show that a sequential approach including induction followed by consolidation/maintenance therapy is an optimal strategy to improve patient outcome. In addition, second-generation novel agents are currently under investigation and may represent valuable alternative treatment options in the future.Seminars in Oncology 10/2013; 40(5):577-84. · 3.94 Impact Factor