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Monoclonal Gammopathy of Undetermined Significance (MGUS)

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Published on July 13, 2020

MGUS (Monoclonal Gammopathy of Undetermined Significance) is diagnosed when the presence of an abnormal protein created in the bone marrow, known as a monoclonal or M protein, is detected but not at a level that would be considered "cancer" and with no end-organ damage.
 
"There are lots of people running around with MGUS and most of them never get cancer," explains Dr. James Berenson, Founder, President, and Medical and Scientific Director, Institute for Myeloma and Bone Cancer Research.
 
Dr. Berenson and Patient Power co-founder Andrew Schorr discuss MGUS (Monoclonal Gammopathy of Undetermined Significance) and the risk of it developing into multiple myeloma.
 

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Transcript | Monoclonal Gammopathy of Undetermined Significance (MGUS)

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Dr. Berenson, how would you define MGUS?

Dr. Berenson:

MGUS is defined as having a monoclonal protein of antibody type that's detectable in the blood or urine, but a monoclonal gammopathy can exist in a cancerous form, which may be myeloma most commonly, less commonly macroglobulinemia Waldenstrom's, but much more common than any of this is a so-called monoclonal gammopathy of undetermined significance or MGUS in which you harbor the protein, but you don't have a form of cancer. And that's because you don't have enough plasma cells in your marrow that is more than 10% to call it cancer or myeloma. And you don't have any end organ damage like anemia from it, bone disease, kidney disease, high calcium. So there are a lot more people running around with MGUS than myeloma or macroglobulinemia. And most of them fortunately never get cancer.

Andrew Schorr:

Okay. So if you have somebody who you see and you identify MGUS, they shouldn't be freaking out.

Dr. Berenson:

No, I don't think they should. They're going to have a long life and they should be fine. I have some pretty OCD patients, including what I spoke to yesterday, who follows his M protein. And then now his BCMA very closely, but no, most people do fine. The risk of going to active myeloma is probably less than 1% per year. Overall, there's some higher risk features. And those include the size of the M protein, the type of M protein and whether the free light numbers are off. And now it turns out our number of the BCMA. And there seems to be a limbo number, if you're below that number, you're probably never going to get myeloma and you can be really reassured.

Andrew Schorr:

Smoldering myeloma people like Jason, your patient, have it and worry about it. So is that usually the name of the game they're simply monitoring every three, six months?

Dr. Berenson:

Yeah. I always say if you don't like your myeloma labs, repeat them, you liked them better second time. I've seen that twice in the last few days where these patients were in complete remission and then their number bumped and I repeat them and they were normal again. Especially the free light chain tends to water all over the place. Usually that's not as true if the M protein is really going up, but the free light can move all over.

Andrew Schorr:

Okay. So smoldering myeloma, though, you do look at a trend and at some point certainly you may say, you know what we need to treat.

Dr. Berenson:

Yeah, that's true. But it's pretty subjective of when to make the treatment decision in the absence of anemia, kidney disease, or bone disease or high calcium. But if it's going up radically like doubling every few months then you got to jump in.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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