Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ONGOING

confirmed MGUS

1st line – counseling

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ONGOING
|
confirmed MGUS
1st line – 

counseling

Once MGUS is diagnosed, patients must be appropriately counseled that it is a premalignant entity with a relatively low risk of progression. Patients who have MGUS with monoclonal (M) proteins <1.5 g/dL and with a normal serum free light chain ratio account for about 40% of all cases and have only a 2% lifetime probability of developing multiple myeloma or related malignancies.[29]

Plus – monitoring

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ONGOING
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confirmed MGUS
Plus – 

monitoring

Treatment recommended for ALL patients in selected patient group

Because patient risk stratification can be difficult and there are no markers or clinical findings at diagnosis to determine whether a specific patient is at risk of progression (to multiple myeloma or related plasma cell proliferative malignancy), many experts recommend that all MGUS patients should be followed up annually (for life) to detect serious disease before complications such as renal failure or pathologic fractures occur. Clinicians must use clinical measures in combination with routine blood tests (including renal function, hemoglobin, and serum calcium) and serum and urine monoclonal (M) protein markers to monitor MGUS patients.[32]​ 

International Myeloma Working Group (IMWG) guidelines recommend that patients diagnosed with intermediate-risk or high-risk MGUS should be followed up 6 months after initial detection, and then annually for life.[35] One study suggested that low-risk MGUS patients may not need to be followed up annually but rather can be followed up if they have new symptoms or signs such as bone pain, weight loss, fatigue, bleeding, disrupted urinary function, repeated infections, or other symptoms suggesting progression.[29][33] For patients with a low-risk stratification at diagnosis, IMWG guidelines recommend serum protein electrophoresis in 6 months and, if stable, follow-up every 2-3 years.[35]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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