Management of MGUS - Information for general practitioners

Several disorders are associated with the presence of a monoclonal protein. These include Myeloma, Lymphoma, CLL and MGUS. The protein is most often IgG. Lymphoma will most often also present with enlarged lymph nodes. CLL will most often have an elevated lymphocyte count. Myeloma will often have a higher level of monoclonal protein as well as bone or kidney problems.

MGUS is the most common cause of a monoclonal protein (paraprotein) found when doing a serum protein electrophoresis (SPE) test. It is extremely common, found in 1% of people above 25 years, 3% above 70 years and up to 10% above 80 years of age. Other causes of a monoclonal protein (above) should be excluded by history, physical examination, full blood count (FBC) and biochemistry (creatinine and calcium). MGUS is asymptomatic and non-progressive and any significant symptom or rise in protein level should be cause for reassessment.

Approximately 1% of people with an MGUS progress to myeloma each year. The majority do not. By measuring the SFLC (Serum Free Light Chains), people can be further divided for their risk of progression:

For most people, follow up every 6-12 months will be adequate with history, examination, FBC, creatinine, calcium, SPE.

Reasons for referral:


About this Canterbury DHB document (26768):
Document Owner:	Amy Holmes (see Who's Who)
Last Reviewed:	September 2014
Next Review:	September 2016
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Assess 3 factors:
paraprotein level > 15 g/L	1 point
abnormal SFLC ratio	1 point
non-IgG protein (i.e., IgA, IgM)	1 point

Number of factors	Risk of progression at 20 years
No abnormal factors	2%
1 factor	10%
2 factors	18%
3 factors	27%

Management of MGUS - Information for general practitioners

MGUS (Monoclonal Gammopathy of Undetermined Significance)

Reasons for referral: