title: Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management.
abstract: Monoclonal gammopathy of undetermined significance (MGUS) was identified in 3.2% of 21 463 residents of Olmsted County, Minnesota, 50 years of age or older. The risk of progression to multiple myeloma, Waldenstrom's macroglobulinemia, AL amyloidosis or a lymphoproliferative disorder is approximately 1% per year. Low-risk MGUS is characterized by having an M protein <15 g/l, IgG type and a normal free light chain (FLC) ratio. Patients should be followed with serum protein electrophoresis at six months and, if stable, can be followed every 2-3 years or when symptoms suggestive of a plasma cell malignancy arise. Patients with intermediate and high-risk MGUS should be followed in 6 months and then annually for life. The risk of smoldering (asymptomatic) multiple myeloma (SMM) progressing to multiple myeloma or a related disorder is 10% per year for the first 5 years, 3% per year for the next 5 years and 1-2% per year for the next 10 years. Testing should be done 2-3 months after the initial recognition of SMM. If the results are stable, the patient should be followed every 4-6 months for 1 year and, if stable, every 6-12 months.
authors.affiliation: Division of Hematology, Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. kyle.robert@mayo.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Kyle
authors.forename: B G M
authors.initials: BG
authors.lastname: Durie
authors.forename: S V
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: O
authors.initials: O
authors.lastname: Landgren
authors.forename: J
authors.initials: J
authors.lastname: Blade
authors.forename: G
authors.initials: G
authors.lastname: Merlini
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: H
authors.initials: H
authors.lastname: Einsele
authors.forename: D H
authors.initials: DH
authors.lastname: Vesole
authors.forename: M
authors.initials: M
authors.lastname: Dimopoulos
authors.forename: J
authors.initials: J
authors.lastname: San Miguel
authors.forename: H
authors.initials: H
authors.lastname: Avet-Loiseau
authors.forename: R
authors.initials: R
authors.lastname: Hajek
authors.forename: W M
authors.initials: WM
authors.lastname: Chen
authors.forename: K C
authors.initials: KC
authors.lastname: Anderson
authors.forename: H
authors.initials: H
authors.lastname: Ludwig
authors.forename: P
authors.initials: P
authors.lastname: Sonneveld
authors.forename: S
authors.initials: S
authors.lastname: Pavlovsky
authors.forename: A
authors.initials: A
authors.lastname: Palumbo
authors.forename: P G
authors.initials: PG
authors.lastname: Richardson
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: P
authors.initials: P
authors.lastname: Greipp
authors.forename: R
authors.initials: R
authors.lastname: Vescio
authors.forename: I
authors.initials: I
authors.lastname: Turesson
authors.forename: J
authors.initials: J
authors.lastname: Westin
authors.forename: M
authors.initials: M
authors.lastname: Boccadoro
mesh_terms: D018450:Disease Progression; D006801:Humans; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D009101:Multiple Myeloma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors
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