Copyright ©2012 Baishideng. All rights reserved.
World J Hematol. Aug 6, 2012; 1(2): 5-7
Published online Aug 6, 2012. doi: 10.5315/wjh.v1.i2.5
MGUS: Proposal for outpatient management
Paolo Savini, Giorgio Marano, Arianna Lanzi, Barbara Castagnari, Giuseppe Musardo, Annalia Molinari, Claudia Cellini, Giuseppe Francesco Stefanini
Paolo Savini, Giorgio Marano, Arianna Lanzi, Giuseppe Musardo, Giuseppe Francesco Stefanini, Department of Internal Medicine, Faenza Hospital, viale Stradone 9, 48018 Faenza, Italy
Barbara Castagnari, Claudia Cellini, Department of Haematology, Ravenna Hospital, viale Randi 5, 48100 Ravenna, Italy
Annalia Molinari, Haematology Unit, Rimini Hospital, via L. Settembrini 2, 47900 Rimini, Italy
Author contributions: All authors contributed to this manuscript.
Correspondence to: Paolo Savini, MD, Department of Internal Medicine, Faenza Hospital, viale Stradone 9, 48018 Faenza, Italy. p.savini@ausl.ra.it
Telephone: +39-546-601111 Fax: +39-546-601517
Received: January 25, 2012
Revised: July 10, 2012
Accepted: July 20, 2012
Published online: August 6, 2012

The term monoclonal gammopathy of undetermined significance (MGUS) indicates the presence of a monoclonal protein (M-protein) without features of multiple myeloma, Waldenström’s macroglobulinemia, primary amyloidosis or malignant lymphoproliferative disorders (LPD). While several guidelines on the treatment of LPD exist, many doubts and perplexities still exist on who should treat a MGUS, when and how. Even where MGUS does not require any therapy, the risk of progression to a LPD is 1% per year. This risk does not diminish over time and persists even in patients (pts) whose condition has remained stable for decades, and a prolonged follow up is, therefore, recommended. We met primary care doctors to share and agree on criteria for the management of outpatients with MGUS. Our aim is to draw up guidelines or, at least, suggestions that may help to determine which MGUS pts could be cared for by the primary care doctor and which should be followed by the hematologist. We suggest that once a MGUS is diagnosed, the primary care physician will attend patients with M-protein < 15 g/L if IgG and pts with M-protein < 10 g/L if IgA or IgM, without end-organ damage and without signs and symptoms of LPD. However, a hematological evaluation is recommended for patients with M-protein IgG > 15 g/L, or M-protein IgA > 10 g/L, or IgM > 10 g/L, or any M-protein with end-organ damage (not attributable to any others causes) or with signs and symptoms of LPD, or rapidly increasing M-protein (> 5 g/L per year).

Keywords: Monoclonal gammopathy, Multiple myeloma, Macroglobulinaemia, End-organ damage, Serum protein electrophoresis