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Several disorders are associated with the presence of a monoclonal protein in the blood, including Multiple Myeloma, Lymphoma, Chronic Lymphocytic Leukaemia (CLL) and MGUS.
MGUS is defined by a low level of monoclonal protein (less than 30 g/L) and the absence of anaemia, hypercalcaemia, lytic bone lesions, and renal failure attributable to a plasma cell disorder or lymphoma. It is asymptomatic and very common; found in 3% of over 70 years, and up to 10% in over 80 years of age.
MGUS does not require treatment but there is a potential to progress to symptomatic multiple myeloma (MM) or lymphoma and therefore the condition needs long term clinical follow-up once detected.
If fever, malaise, bone pain, lymphadenopathy, hepatosplenomegaly, kidney problems, exclude significant causes of a monoclonal protein:
Risk of progression
Overall, approximately 1% of patients with MGUS progress to myeloma each year. Risk factors associated with a higher chance of progressing to symptomatic disease are listed below.
|Assess 3 factors:|
|paraprotein level > 15 g/L||1 point|
|abnormal serum free light chain ratio||1 point|
|non-IgG protein (i.e., IgA, IgE)||1 point|
|Number of Factors||Risk of progression at 20 years|
|No abnormal factors||5%|
Bloods - full blood count, creatinine, calcium, albumin, serum protein electrophoresis (SPE) with immunoglobulin levels, and urine Bence-Jones Protein (BJP).
MGUS can often be managed with regular monitoring through general practice. A suggested treatment algorithm is illustrated below. It is derived from the British Committee for Standards in Haematology guidelines 1.
Low Risk, group who clinician is concerned with during primary care follow up
e-Referral Service Selection
This guideline has been signed off by NEW Devon CCG.
Publication date: July 2016