Monoclonal Gammopathy of Undetermined Significance: Current Concepts and Future Prospects

Seth, Shivani; Zanwar, Saurabh; Vu, Linh Gia; Kapoor, Prashant

doi:10.1007/s11899-020-00569-2

Cited by 11 publications

(10 citation statements)

References 76 publications

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“…A Mayo Clinic study of patients older than the age of 50 years with TMA identified 21% of patients with an underlying monoclonal gammopathy, a number higher than the 4.2% to 6% prevalence of MGUS in the general population older than the age of 50 years. 7,9 The absence of monoclonal immunoglobulin deposition in renal structures and lack of correlation between concentration of M-spike and disease severity in MGUSassociated TMA have led to a number of possible pathophysiologic hypotheses: (1) low levels of monoclonal protein are able to dysregulate the alternative complement pathway by targeting complement regulatory proteins such as complement factor H or by stabilizing C3 convertase 8 ; (2) immunoglobulin G antibody against ADAMTS13 causing TTP; and/or (3) free light chains that filter through the glomerulus induce an inflammatory cascade which damages the renal endothelium. 10 However, no studies to date have proven a causal relationship between monoclonal gammopathies and TMA and it is also yet unclear if the monoclonal protein is directly involved in the pathogenesis of TMA.…”

Section: Discussionmentioning

confidence: 99%

44-Year-Old Man With Anemia, Thrombocytopenia, and Acute Kidney Injury

Zanwar

Gertz

2022

Mayo Clinic Proceedings

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44-year-old man presented with a 3-month history of progressive generalized weakness, polyarthralgia, polymyalgia, fatigue, unintentional 11 kg (13%) weight loss, and vision loss. His medical history is significant for hypothyroidism, melanoma in remission, spongiotic dermatitis that resolved with prednisone, Raynaud disease, and recently diagnosed monoclonal gammopathy of undetermined significance (MGUS). His ongoing medications include levothyroxine (75 ug), lisinopril (20 mg), omeprazole (40 mg), prednisone (40 mg), sulfamethoxazoletrimethoprim (400 to 80 mg), sumatriptan (50 mg as needed), and zolpidem (5 mg as needed). He denies recent diarrhea, fevers, chills, night sweats, easy bruising, hypertension, or bleeding. Family history was notable for psoriasis but negative for other autoimmune or renal disease. On exam, the patient was afebrile with a heart rate of 63 beats/ min, respiratory rate 14 breaths/min, blood pressure 131/88 mm Hg, and oxygen saturation 97% on room air. He was alert, orientated, and not in acute distress. Cardiovascular exam revealed an irregularly irregular pulse without murmurs, gallops, or rubs. Lungs were clear to auscultation with good air entry bilaterally. Skin exam was negative for rash, sclerodactyly, or calcinosis. Fundoscopic exam was significant for bilateral beading of retinal vessels, intraretinal hemorrhages, and cotton wool spots.Laboratory studies revealed the following results (reference ranges in parentheses): hemoglobin level, 11.3 g/dL (13.7 to 17.5 g/ dL); mean corpuscular volume (MCV), 95.5 fL (80 to 100 fL); white blood cell count, 12.8Â10 9 /L (3.4 to 9.6Â10 9 /L); platelet count, 65Â10 9 /L (135 to 317Â10 9 /L); blood urea nitrogen, 41 mg/dL (6 to 24 mg/dL);

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Section: Discussionmentioning

confidence: 99%

44-Year-Old Man With Anemia, Thrombocytopenia, and Acute Kidney Injury

Zanwar

Gertz

2022

Mayo Clinic Proceedings

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“…Diagnostic criteria for MGUS are the following: serum M-protein <30 g/L, bone marrow clonal plasma cells <10%, absence of end-organ damage related to plasma cell neoplasms and absence of diseases producing an M-protein. MGUS is considered a preneoplastic plasma cell disorder that does not always progress to overt malignancy [ 1 , 2 , 3 , 4 ]. This disorder affects about 3.5% of the population with an age >50 years; progression of MGUS to MM or other related neoplasms occurs at a rate of about 1% per year [ 1 , 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…MGUS is considered a preneoplastic plasma cell disorder that does not always progress to overt malignancy [ 1 , 2 , 3 , 4 ]. This disorder affects about 3.5% of the population with an age >50 years; progression of MGUS to MM or other related neoplasms occurs at a rate of about 1% per year [ 1 , 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

The “Undetermined Significance” of 18F-FDG PET/CT or PET/MRI in Patients with Monoclonal Gammopathy of Undetermined Significance (MGUS)

2021

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Monoclonal gammopathy of undetermined significance (MGUS) is a highly prevalent condition with the possible risk of progression to multiple myeloma (MM) or a lymphoproliferative neoplasm in a small percentage of patients. Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) or positron emission tomography/magnetic resonance imaging (PET/MRI) are imaging methods increasingly used in patients with MM. The aim of this communication is to underline that, taking into account current evidence-based data, compared to MM the role of 18F-FDG PET/CT or PET/MRI in MGUS is still undetermined and more studies should be performed before suggesting 18F-FDG PET/CT or PET/MRI for evaluation of MM progression in patients with MGUS.

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“…Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant clonal plasma cell dyscrasia characterized by the presence of a monoclonal immunoglobulin, in the absence of multiple myeloma (MM) or any related lymphoplasmacytic malignancies. 1 There is a recently accepted term-monoclonal gammopathy of clinical significance (MGCS)-used in order to describe monoclonal gammopathies that do not meet the diagnostic criteria for symptomatic MM, but different from MGUS and smoldering MM. 2 The MGCSs can be divided into the systems that are affected, broadly into the involving signs and symptoms referable to the nerves, the kidneys, and the skin.…”

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confidence: 99%