Monoclonal gammopathy of undetermined significance is not a malignant condition but over a period of time, it may become malignant.1 The disease is characterized by the presence of monoclonal (M) protein, clonal plasma cells, and the absence of any lymphoplasmacytic cancerous cells. MGUS in certain cases can turn into blood malignancies.
Can MGUS Or Monoclonal Gammopathy Of Undetermined Significance Be Reversed?
Monoclonal gammopathy of undetermined significance cannot be reversed and the progression of the disease cannot be controlled.2
Many patients who are diagnosed with monoclonal gammopathy of undetermined significance will be detected by M-protein while testing for other diseases. Patients who show symptoms of bone pain, unexplained weight loss and hyperviscosity, these patients will often be suffering from multiple myeloma, amyloidosis or other serious blood disorders.
The tests performed for monoclonal gammopathy include serum protein electrophoresis (SPEP), serum immunofixation, and free light chain (FLC). This is followed by urine protein electrophoresis. These tests are highly sensitive and detect M protein efficiently in patients with LPMs.
Patients who do not have any symptoms of the disease are not recommended for routine analysis for MGUS. There is no treatment or prevention of monoclonal gammopathy of undetermined significance hence doctors do not advise for M-protein analysis. Most of the people tested for MGUS are not clinically diagnosed, only the patients who are at risk and have developed symptoms for related diseases should be proposed for regular M-protein diagnosis.
Once the M proteins are detected then the explanation for M proteins whether it is due to LPM or other medical conditions is determined. MGUS is confirmed by complete blood count, serum calcium, creatinine, FLC, immunofixation, and 24-hour urine protein electrophoresis.
Monoclonal gammopathy of undetermined significance can further be classified as follows:
Immunoglobulin M (IgM) MGUS. The serum indicates the presence of IgM monoclonal protein <3 gm/dL. Apart from this, the patients are diagnosed with symptoms of hyperviscosity, lymphadenopathy, or hepatosplenomegaly indicating a lymphoproliferative disorder.
Non-IgM MGUS. The serum indicates monoclonal protein (non-IgM type) <3 gm/dL. There will not be any symptoms of hypercalcemia, renal insufficiency, anemia, and bone lesions.
Light-Chain MGUS. During immunofixation, there will be increased amounts of light chain and no heavy-chain expression can be seen. The symptoms do not indicate end-organ damage which can be attributed to the plasma cell proliferative disorder.
Although, there is no treatment for certain lymphoproliferative malignancies such as multiple myeloma, the earlier diagnosis can help in preventing complications, improving the symptoms and increasing the survival time. Doctors request for laboratory reports of complete blood count, SPEP, FLC, calcium, and creatinine of patients. Patients who are developing the complication of the disease in the form of decreased bone density, bone lesion, cardiomyopathy or decreased red blood cell count are at increased risk of developing threatening blood malignancies.
As discussed, older patients are at increased risk of developing multiple myeloma following monoclonal gammopathy of undetermined significance; these patients (older than 85 years) need not be followed-up.
In 50% of the diagnosed patients, there will be a rapid increase in serum M-protein. This raises concern among both patients and doctors about the risk of possible malignancies. The diagnosis becomes very difficult when there are constant changes in the laboratory parameters of hemoglobin, calcium, or creatinine.
Diagnosis of monoclonal gammopathy of undetermined significance creates psychological stress in patients are there is a possibility of developing malignancy and a decrease in the survival rate. The panic triggered should be handled with the utmost care by family and friends and if required medical attention should be sought to eliminate or reduce stress.
Patients who are diagnosed with MGUS are advised regular screening at 6 months interval of time to monitor the progression of the disease and seek medical attention for longer survival time. The patients are advised to be monitored for blood count, SPEP, FLC, calcium, and creatinine. Patients who are at risk of developing lymphoproliferative disorders and present symptoms of anemia, cardiomyopathy, hypercalcemia, diarrhea, or neuropathy should have their regular follow-up on visits and the test. Other patients without symptoms but at risk of increasing M. proteins and developing proliferative disorders can be monitored yearly.
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