Updated: 8/4/2019

Monoclonal Gammopathy of Undetermined Significance (MGUS)

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Snapshot
  • A 55-year-old man presents to his primary care physician for evaluation of his peripheral neuropathy. He otherwise feels well. Physical examination is notable for decreased sensation to pinprick in the bilateral lower extremities. Laboratory studies were notable for an M spike in protein electrophoresis of the blood and M protein at a concentration of 2 g/dL in the serum. He undergoes a bone marrow biopsy, which demonstrates 4% monoclonal plasma cells. 
Introduction
  • Overview
    • premalignant clonal plasma cell disorder
      • no evidence of multiple myeloma
        • no CRAB findings
          • hyperCalcemia
          • Renal insufficiency
          • Anemia
          • Bone lytic lesions
      • no evidence of amyloidosis that is attributed to a plasma cell proliferative disorder
  • Epidemiology
    • incidence
      • > 3% of the general population in patients > 50 years of age
    • risk factors
      • black race
      • family history
      • radiation exposure
  • Pathophysiology
    • not fully clear; however, several oncogenic events affecting the plasma cell leads to clonal expansion
      • leads to the overproduction of monoclonal proteins
  • Prognosis
    • associated with lower survival than the general population
      • may be due to the development of multiple myeloma or other lymphoproliferative malignancies
Presentation
  • Symptoms/physical exam
    • discovered incidentally when evaluating for other conditions
    • asymptomatic
Studies
  • Serum labs
    • protein electrophoresis of the serum or urine
      • M spike
    • monoclonal M protein (< 3 g/dL)
  • Invasive studies
    • bone marrow biopsy
      • < 10% monoclonal plasma cells
Differential
  • Multple myeloma 
    • distinguishing factors
      • CRAB findings
      • ≥ 10% clonal plasma cells
Treatment
  • Lifestyle
    • monitoring
      • indication
        • management of choice
          • must monitor patient for progression to malignant disease
Complications
  • Multiple myeloma
  • Other lymphoproliferative disorders

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