title: Impact of optimal follow-up of monoclonal gammopathy of undetermined significance on early diagnosis and prevention of myeloma-related complications.
abstract: Monoclonal gammopathy of undetermined significance (MGUS) is associated with a long-term risk of progression to multiple myeloma (MM) or related malignancy. 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%, whereas MM was diagnosed only after serious MM-related complications in 45%. In the remaining, workup of less serious symptoms (25%), incidental finding during workup of unrelated medical conditions (11%), and unknown (3%) were the mechanisms leading to MM diagnosis. High-risk MGUS patients (≥ 1.5 g/dL and/or non-IgG MGUS) were more likely to be optimally followed (81% vs 64%), and be diagnosed with MM secondary to serial follow-up testing (21% vs 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.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Giada
authors.initials: G
authors.lastname: Bianchi
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Colin L
authors.initials: CL
authors.lastname: Colby
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Katzmann
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D006801:Humans; D008875:Middle Aged; D008910:Minnesota; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications / Q000175:diagnosis*; D009101:Multiple Myeloma / Q000517:prevention & control*; D019370:Observation; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies