Impact of Optimal Follow-up of Monoclonal Gammopathy of Undetermined Significance (MGUS) on Early Diagnosis and Prevention of Myeloma-Related Complications
Blood. 2010 May 21;[Epub Ahead of Print], G Bianchi, RA Kyle, CL Colby, DR Larson, S Kumar, JA Katzmann, A Dispenzieri, TM Therneau, JR Cerhan, LJ Melton III, SV Rajkumar
ABSTRACT
Monoclonal Gammopathy of Undetermined Significance (MGUS) is associated with a long-term risk of progression to multiple myeloma (MM) or related malignancy. In order to prevent serious myeloma-related complications, lifelong annual follow-up has been recommended, but its value is unknown. We reviewed all patients from southeastern Minnesota seen at Mayo Clinic between 1973 and 2004 with MGUS who subsequently progressed to MM. Of 116 patients, 69% had optimal follow-up of MGUS. Among these, abnormalities on serial follow-up laboratory testing led to the diagnosis of MM in 16%, while MM was diagnosed only following serious MM-related complications in 45%. In the remaining, work-up of less serious symptoms (25%), incidental finding during work-up of unrelated medical conditions (11%), and unknown (3%) were the mechanisms leading to MM diagnosis. High-risk MGUS patients (≥1.5gm/dL and/or non IgG MGUS) were more likely to be optimally followed (81% versus 64%), and be diagnosed with MM secondary to serial follow-up testing (21% versus 7%). This retrospective study suggests that routine annual follow-up of MGUS may not be required in low-risk MGUS. Future studies are needed to replicate and expand our findings, and to determine the optimal frequency of monitoring in higher risk MGUS patients.
