Demystifying MGUS

A week ago I promised to pass along more information about MGUS and smoldering multiple myeloma.  I hear from readers with both conditions often.  They are often anxious and stressed about their uncertain futures.

I understand!  Learning that you have a chance of developing cancer is a frightening thing.  But after researching MGUS (monoclonal gammopathy of undetermined significance) or a while, I began to wonder if this fear is justified for those diagnosed with MGUS.

Here is an excellent explanation about what MGUS is by an international expert in the field, Dr. Giampaolo Merlini:

MGUS is one of the most common premalignant disorders in the general population, occurring in over 3% of individuals ≥50 years old. It is predominantly diagnosed incidentally and is characterized by the presence of a serum monoclonal (M) protein in the absence of symptoms, with an unrelenting annual risk of progression to multiple myeloma (MM) or related plasma cell (PC) disorders of approximately 1%.2 Although virtually all patients with MM have a previously recognized MGUS, most cases of MGUS do not progress toward malignancy. Differentiating low-risk patients, who may not need further follow-up, from high-risk patients, who warrant close monitoring, is challenging.

MGUS docDr. Merlini is a Professor of Clinical Biochemistry and the Director of the Center for Research and Treatment of Systemic Amyloidosis, and of the Biotechnology Research Laboratories, Scientific Institute Policlinico San Matteo, University of Pavia, Italy.  I’m quoting him from a paper he wrote that was recently published earlier this year in the Journal of the American Society of Hematology (Blood).  Here’s the link:

Challenging, but possible?  Apparently not yet.  Here is how Dr. Merlini summarized his report:

Although only a fraction of MGUS cases (21% of 70-year-olds)10 are recognized during routine clinical practice, the current consensus is still that screening for MGUS should not be performed, considering the generally low risk of progression to malignancy, related emotional burden, and lack of effective interventions. However, because it is now possible to rapidly identify low-risk individuals (thus reducing the economic and emotional burden for approximately 40% of cases), we can focus on the remaining 60%, with careful monitoring, in order to detect progression promptly and anticipate end-organ damage.4 If evidence of clinical benefit of early interventions11 is consolidated, we could likely reconsider our current practice, adopting a more proactive search for M protein in clinical practice.

Available biomarkers are enabling clinicians to risk stratify individuals with MGUS, optimizing their management. Novel, biologically relevant markers, in combination with imaging techniques, have the potential to change our clinical practice throughout the spectrum of monoclonal gammopathies.

Looks like researchers are having trouble linking all of their new-found genetic information together.  Who is most likely to be part of that annual 1% number?  Wouldn’t that be good to know?

Still, 1%?  A healthy sixty year old woman walking down the street in Chicago today has a greater risk of developing cancer than that.  So does that mean the fears of those of you diagnosed with MGUS aren’t justified?  Possibly.  But that’s the thing about fear and anxiety; it’s often not logical or rational.  How we feel is how we feel.  But I hope this positive report about MGUS will help dissuade some of our reader’s fears.

Later this week I’ll take a closer look at smoldering myeloma.  Much higher chance of that progressing to symptomatic myeloma than with MGUS.

Feel good and keep smiling!  Pat

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