The incidental monoclonal protein: Current approach to management of monoclonal gammopathy of undetermined significance (MGUS)

Disentangling age, gender, and racial/ethnic disparities in multiple myeloma burden: a modeling study

Multiple myeloma (MM) is a hematological malignancy that is consistently preceded by an asymptomatic condition, monoclonal gammopathy of undetermined significance (MGUS). Disparities by age, gender, and race/ethnicity in both MGUS and MM are well-established. However, it remains unclear whether these disparities can be explained by increased incidence of MGUS and/or accelerated progression from MGUS to MM. Here, we fit a mathematical model to nationally representative data from the United States and showed that the difference in MM incidence can be explained by an increased incidence of MGUS among male and non-Hispanic Black populations. We did not find evidence showing differences in the rate of progression from MGUS to MM by either gender or race/ethnicity. Our results suggest that screening for MGUS among high-risk groups (e.g., non-Hispanic Black men) may hold promise as a strategy to reduce the burden and MM health disparities.

Imaging for Plasma Cell Dyscrasias: What, When, and How?

Imaging plays a vital role in the diagnosis, response assessment, and follow-up of patients with plasma cell bone disease. The radiologic diagnostic paradigm has thus far evolved with developing technology and availability of better imaging platforms; however, the skewed availability of these imaging modalities in developed vis-à-vis the developing countries along with the lack of uniformity in reporting has led to a consensus on the imaging criteria for diagnosing and response assessment in plasma cell dyscrasia. Therefore, it is imperative for not only the radiologists but also the treating oncologist to be aware of the criteria and appropriate imaging modality to be used in accordance with the clinical question. The review will allow the treating oncologist to answer the following questions on the diagnostic, prognostic, and predictive abilities of various imaging modalities for plasma cell dyscrasia: a) What lesions can look like multiple myeloma (MM) but are not?; b) Does the patient have MM? To diagnose MM in a high-risk SMM patient with clinical suspicion, which modality should be used and why?; c) Is the patient responding to therapy on follow-up imaging once treatment is initiated?; d) To interpret commonly seen complications post-therapy, when is it a disease and when is the expected sequel to treatment? Fractures, red marrow reconversion?; and e) When is the appropriate time to flag a patient for further workup when interpreting MRI spine done for back pain in the elderly? How do we differentiate between commonly seen osteoporosis-related degenerative spine versus marrow infiltrative disorder?

Neurologic aspects of lymphoma and leukemias

The lymphomas and leukemias are a heterogenous group of hematologic malignancies with protean manifestations. Neurologic sequelae of the diseases have been recognized since the time the conditions were first described in the mid-1800s. Although our understanding of the various presentations of these blood disorders evolved along with our knowledge of malignancies, accurate diagnosis can still be difficult. It is critical for neurologists to have a high index of clinical suspicion to appropriately recognize their heralding features. This review's focus is the relevant clinical neurologic features and diagnostic studies that identify leukemias and lymphomas affecting the nervous system.

Incidental finding of monoclonal gammopathy in blood donors: a follow-up study

BACKGROUND

The incidental finding of monoclonal immunoglobulin in the sera of healthy blood donors is a relatively frequent event and in such cases the subjects are commonly deferred permanently from donating blood. However, no follow-up studies of these cases have been published so far.

MATERIALS AND METHODS

Since 2000, all regular blood donors at Trieste Blood Bank have undergone annual screening by serum protein electrophoresis. Cases presenting with monoclonal gammopathy between January 2000 and December 2008 were registered and follow-up was performed until December 2010.

RESULTS

Out of 8,197 regular blood donors, monoclonal gammopathy was detected in 104 subjects (1.3%). The median age at detection was 53 years, the median monoclonal protein concentration was 0.2 g/dL and the cumulative follow-up of these cases amounted to 763 person/years. In two cases asymptomatic multiple myeloma was diagnosed within 6 months of detection of the gammopathy and in 14 cases, the monoclonal gammopathy was transient. The remaining 88 cases were classified as having monoclonal gammopathy of undetermined significance (MGUS). Out of these, two events related to monoclonal gammopathy were observed during the follow up: one lymphoma and one light chain deposition nephropathy.

DISCUSSION

According to current prognostic staging systems, the majority of blood donors with monoclonal gammopathy were classified as having low-risk MGUS and had a very low incidence of lymphoproliferative diseases. Permanent deferral of blood donors with stable MGUS causes about a 1% loss of potential blood donations and it represents a "precautionary measure" that needs to be substantiated and validated.

Development of MGUS in psoriatic patients: a possible undiagnosed event during anti-TNF-α-treatment

BACKGROUND

Monoclonal gammopathies are haematological conditions characterized by the clonal proliferation of plasma cells which produce a monoclonal immunoglobulin that accumulates in the blood. They have already been reported during treatment with a range of drugs but never before during treatment with the anti-TNF-α treatments: adalimumab, etanercept and infliximab currently used in the therapy of moderate-severe psoriasis and psoriatic arthritis.

OBJECTIVE

This is a case series describing the development of MGUS in psoriatic patients treated with anti-TNF-α.

METHODS

Three hundred patients receiving an anti-TNF-α treatment for chronic plaque psoriasis or psoriatic arthritis in a clinical setting in Italy, These patients were screened through serum protein electrophoresis to investigate the possible development of MGUS.

RESULTS

Eight patients were found to have developed monoclonal gammopathy of undetermined significance. The median treatment duration for the eight patients was 1 year with excessive IgG present in five patients, IgM accumulation in one patient and a double monoclonal component in two patients.

CONCLUSION

Our data suggest that there may be an association between anti-TNF-α therapy and development of MGUS.

Neurologic aspects of lymphoma and leukemias

The leukemias and lymphomas represent a heterogenous group of hematologic malignancies with protean manifestations. Neurologic sequelae of the diseases have been recognized almost since the time the conditions were first described in the mid-1800s. Although our understanding of the various presentations of these blood disorders has evolved along with our knowledge of the malignancies, accurate diagnosis can still be difficult. It is critical for neurologists to have a high index of clinical suspicion to appropriately recognize the heralding features. This review focuses on the relevant clinical neurologic features and diagnostic studies to identify leukemias and lymphomas affecting the nervous system.