Management of patients with MGUS

Dr Chris Hillis is an assistant professor in the Division of Oncology at McMaster University and hematologist at the Juravinski Hospital and Cancer Centre.

Patients with monoclonal gammopathy of unknown significance (MGUS), a common condition among the elderly, are at low risk for progression to plasma cell myeloma (multiple myeloma). Who should take care of these patients: hematologists and oncologists? Or general practitioners?

Chris Hillis, MD, MSc: I think this is a great example of a condition that can be followed in primary care.

Certainly it is becoming increasingly prevalent as the population ages, with at least 3% of patients over 70 years of age having a diagnosis of MGUS. With the new risk stratification criteria we can find a population of patients with MGUS who are at very low risk of progression. If a patient has an IgG monoclonal protein <15 g/L, a normal serum free light chain ratio, and no CRAB (hypercalcemia, renal failure, anemia, bone lesions) features, the chance of progression at 20 years is <5%, and experts are now recommending that such patients require no further follow-up for their MGUS.

If patients are at intermediate or high risk, then annual complete blood counts (CBCs) and checking for CRAB in addition to following up the serum protein electrophoresis is still required. This may be done in primary care but often patients at the higher risk will still be followed by a hematologist-oncologist.