Monoclonal gammopathy of undetermined significance medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]Shyam Patel [3] Muhammad Saad, M.B.B.S.[4]
Overview
The current standard of care for MGUS is monitoring for progression to multiple myeloma. The goal is to detect other plasma cell dyscrasias at an early time point such that corrective intervention can be undertaken. Trials using lenalidomide and bisphosphonates are been conducted to determine whether they decrease the progression of the disease both for MGUS and multiple myeloma.
Medical Therapy
The following recommendation is based on studies showing reduced morbidity and mortality in patients with MGUS who were monitored before progression to multiple myeloma.[1][2][3][4][5]
| Monoclonal protein detected | |||||||||||||||||||||||||||||||||
| Low-risk MGUS | Intermediate- or high-risk MGUS | ||||||||||||||||||||||||||||||||
| Stable? | If bone marrow biopsy and imaging is negative then, at 6 mo, repeat SPEP, IFE, serum FLC, CBC, Creatinine, and Calcium tests | ||||||||||||||||||||||||||||||||
| If yes then at 2-3y, repeat SPEP,IFE,serum FLC, CBC, Creatinine, and calcium tests | If No then shorten interval and/or workup for progression | Stable? | |||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||
| At 1 y, repeat SPEP, IFE, serum FLC, CBC, Creatinine, and Calcium tests | Shorten interval and/or workup for progression | ||||||||||||||||||||||||||||||||
Anti-resorptive therapy
Vitamin D and calcium can be given as anti-resorptive therapy.[6]
Peripheral neuropathy
Corticosteroids may be helpful with peripheral neuropathy. Gabapentin can be considered also.
Advances
Trials using lenalidomide and bisphosphonates are begin run to determine whether they decrease the progression of the disease both for MGUS and multiple myeloma.[7][8][9]
References
- ↑ “British Journal of Haematology | Wiley Online Library”.
- ↑ Kyle RA, Durie BG, Rajkumar SV, Landgren O, Blade J, Merlini G, Kröger N, Einsele H, Vesole DH, Dimopoulos M, San Miguel J, Avet-Loiseau H, Hajek R, Chen WM, Anderson KC, Ludwig H, Sonneveld P, Pavlovsky S, Palumbo A, Richardson PG, Barlogie B, Greipp P, Vescio R, Turesson I, Westin J, Boccadoro M (June 2010). “Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management”. Leukemia. 24 (6): 1121–7. doi:10.1038/leu.2010.60. PMID 20410922.
- ↑ van de Donk NW, Palumbo A, Johnsen HE, Engelhardt M, Gay F, Gregersen H, Hajek R, Kleber M, Ludwig H, Morgan G, Musto P, Plesner T, Sezer O, Terpos E, Waage A, Zweegman S, Einsele H, Sonneveld P, Lokhorst HM (June 2014). “The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: recommendations from the European Myeloma Network”. Haematologica. 99 (6): 984–96. doi:10.3324/haematol.2013.100552. PMID 24658815.
- ↑ Go RS, Gundrum JD, Neuner JM (March 2015). “Determining the clinical significance of monoclonal gammopathy of undetermined significance: a SEER-Medicare population analysis”. Clin Lymphoma Myeloma Leuk. 15 (3): 177–186.e4. doi:10.1016/j.clml.2014.09.004. PMID 25445471.
- ↑ Bianchi G, Kyle RA, Colby CL, Larson DR, Kumar S, Katzmann JA, Dispenzieri A, Therneau TM, Cerhan JR, Melton LJ, Rajkumar SV (September 2010). “Impact of optimal follow-up of monoclonal gammopathy of undetermined significance on early diagnosis and prevention of myeloma-related complications”. Blood. 116 (12): 2019–25, quiz 2197. doi:10.1182/blood-2010-04-277566. PMID 20495076.
- ↑ Berenson JR, Anderson KC, Audell RA, Boccia RV, Coleman M, Dimopoulos MA, Drake MT, Fonseca R, Harousseau JL, Joshua D, Lonial S, Niesvizky R, Palumbo A, Roodman GD, San-Miguel JF, Singhal S, Weber DM, Zangari M, Wirtschafter E, Yellin O, Kyle RA (July 2010). “Monoclonal gammopathy of undetermined significance: a consensus statement”. Br. J. Haematol. 150 (1): 28–38. doi:10.1111/j.1365-2141.2010.08207.x. PMID 20507313.
- ↑ Pozzi S, Raje N (2011). “The role of bisphosphonates in multiple myeloma: mechanisms, side effects, and the future”. Oncologist. 16 (5): 651–62. doi:10.1634/theoncologist.2010-0225. PMC 3228190. PMID 21493759.
- ↑ Mateos MV, Hernández MT, Giraldo P, de la Rubia J, de Arriba F, López Corral L, Rosiñol L, Paiva B, Palomera L, Bargay J, Oriol A, Prosper F, López J, Olavarría E, Quintana N, García JL, Bladé J, Lahuerta JJ, San Miguel JF (August 2013). “Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma”. N. Engl. J. Med. 369 (5): 438–47. doi:10.1056/NEJMoa1300439. PMID 23902483.
- ↑ Mahindra A, Pozzi S, Raje N (September 2012). “Clinical trials of bisphosphonates in multiple myeloma”. Clin Adv Hematol Oncol. 10 (9): 582–7. PMID 23073123.
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