title: Monoclonal gammopathy of undetermined significance does not affect outcomes in patients undergoing solid organ transplants.
abstract: BACKGROUND
  Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic plasma cell proliferative disorder with a lifelong risk of progression to multiple myeloma or another plasma cell dyscrasia. Despite a high incidence in the general population and an increased relative risk for later malignancy, there are few reports about the clinical course of MGUS or risk profile in long-term immunosuppressed patients.
  
  
  METHODS
  We reviewed 1593 solid organ transplant patients and reported the frequency and outcomes of patients with MGUS identified pretransplant.
  
  
  RESULTS
  Polyclonal gammopathy pretransplant is common with 17% of all patients and as many as 75% of liver transplant candidates having increased globulins.However, a monoclonal immunoglobulin was identified in only 3% of all solid organ transplant patients pretransplant (n=34). Importantly, in these 34 patients, no cases of progression to multiple myeloma, amyloid, or lymphoma were observed during immune suppression, and there was no association between posttransplant lymphoproliferative disorders and pretransplant MGUS. Death in MGUS patients was not associated with progression of the monoclonal clone or development of posttransplant lymphoproliferative disorders or other malignancy.
  
  
  CONCLUSIONS
  In conclusion, routine testing for MGUS before transplantation is not prognostic nor a contraindication to transplant, and therefore, it is not recommended.
authors.affiliation: Division of Hematology-Oncology, Mayo Clinic, 13400 E. Shea Boulevard, Scottsdale, AZ 85259, USA.
authors.forename: Victor H
authors.initials: VH
authors.lastname: Jimenez-Zepeda
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Heilman
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Engel
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Carey
authors.forename: Ciara
authors.initials: C
authors.lastname: Freeman
authors.forename: Jorge
authors.initials: J
authors.lastname: Rakela
authors.forename: David C
authors.initials: DC
authors.lastname: Mulligan
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.forename: Alexander Keith
authors.initials: AK
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001797:Blood Protein Electrophoresis; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D009101:Multiple Myeloma / Q000209:etiology / Q000276:immunology; D012307:Risk Factors; D014181:Transplantation Immunology; D019737:Transplants / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult