Management of Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM)
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.
Available from: synapse.koreamed.org
- "We didn't plan any additional management for cryoglobulinemia because there was no life-threatening complication, such as hyper- viscosity. As for MGUS, since there was no evidence of multiple myeloma or Waldenstrom's macroglobulinemia, the patient is under periodic follow-up with serum protein electrophoresis and a complete blood count. "
Available from: Jeannine M Brant
- "An abnormal serum-free light chain ratio, non-IgG MGUS, and a high serum M protein level (> 1.5) are the three risks identified that may predict progression to multiple myeloma. However, an abnormal light chain ratio increases the risk regardless of the type of M protein involved (Kyle et al., 2011; Wadhera & Rajkumar, 2010). "
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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.
Available from: Terry Golombick
- "This diminishes gradually thereafter. SMM is a more advanced pre-malignant condition than monoclonal gammopathy of undetermined significance (MGUS).The cornerstone of managing SMM is a " watch and wait " strategy  . Although it is currently not possible to predict the clinical course of SMM, features predicting patients at highest risk include the size and type of M-protein, with IgA having a higher risk compared to IgG paraprotein, % plasma cell dyscrasia, and an abnormal serum-free light chain ratio. "
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