Monoclonal Gammopathy of Undetermined Significance (MGUS)—Not So Asymptomatic after All

Abstract

Monoclonal Gammopathy of Undetermined Significance (MGUS) is considered to be a benign precursor condition that may progress to a lymphoproliferative disease or multiple myeloma. Most patients do not progress to an overt condition, but nevertheless, MGUS is associated with a shortened life expectancy and, in a minority of cases, a number of co-morbid conditions that include an increased fracture risk, renal impairment, peripheral neuropathy, secondary immunodeficiency, and cardiovascular disease. This review aims to consolidate current evidence for the significance of these co-morbidities before considering how best to approach these symptoms and signs, which are often encountered in primary care or within a number of specialties in secondary care.

Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance: A case report

“…It is characterized by a serum M protein lower than 30 g/L, bone marrow clonal plasma cells less than 10%, no plasma cell myeloma-related terminal organ damage, including hypercalcemia, renal insufficiency, anemia and bone lesions and no B-cell lymphoma or other diseases known to produce M protein. About 3% of people aged over 50 years have MGUS, and these individuals are more likely to have recurrent infections, ischemic heart disease, peripheral neuropathy and kidney disease[ 5 ]. Serum protein electrophoresis can be used to diagnose MGUS.…”

Monoclonal gammopathies of undetermined significance and smoldering myeloma

“…Although there is no specific treatment for MGUS, it has been shown to reduce life expectancy even when a malignant transformation is not Therapy should be modeled after the treatment paradigms for MM targeting the clonal PCs producing the immunoglobulins with the goal of improving/maintaining renal function [60].…”

How We Manage Smoldering Multiple Myeloma

“…Clinical implication of immunoparesis is the secondary antibody deficiency, whose biological contribution to MM evolution is still under investigation 78 . As consequence of both innate and cellular immunity, 18-20 , 26 , 79-81 immunosenescence, 82 T-cell anergy and addiction of neoplastic plasma cells to TLR4 signaling 83 , 84 , SMM patients have increased risk to develop bacterial and viral infections.…”

“… 69 , 85 In patients with active MM, both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) can increase anti-pneumococcal antibodies, and preliminary observations suggest that vaccination is negatively correlated with disease progression. 78 , 86 Even if these preliminary observations have not maturely shown in the SMM setting, it is reasonable that a policy to improve the prevention of viral and bacterial infection should be tested in each single center and offered to all SMM patients with a positive anamnesis for recurrent infections, including immunoglobulin replacement, as suggested by the Canadian group. 87 We suggest that clinical evaluation and anamnestic aspects are fundamental to decide if may be helpful to prescribe or not substitutive therapy in MM.…”