If a patient’s MGUS (monoclonal gammopathy of unknown significance) progresses to asymptomatic or smoldering multiple myeloma, by definition, he/she will not have symptoms from this condition. However, if a patient develops symptomatic multiple myeloma, he/she may note progressive fatigue, frequent infections and bone pain or fractures. In addition, if the multiple myeloma causes kidney failure or high blood calcium levels, lethargy or confusion may occur. During the first year after the diagnosis of MGUS is made, a patient should have regular follow-up with their hematologist/oncologist every three months. If the MGUS appears stable, follow-up appointments can be stretched to every six months for the second year. Thereafter, the MGUS should be followed at least annually to look for evidence of multiple myeloma or another blood cell cancer. With regular follow-up, development of multiple myeloma or another blood cell cancer can often be detected early, before many symptoms develop. Q2. I am 37 years old. I was diagnosed with monoclonal gammopathy of undetermined significance (MGUS) two years ago. The oncologists are watching me carefully every three months with lab work. I had a suspicious bone survey that was repeated last month and the retake X-rays were okay. My spike is immunoglobulin G kappa and is stable. My blood count was very low but corrected with 10 treatments of intravenous iron sucrose, so it’s fine at this time, but eventually drops. This happens often, which warrants repeat of the iron treatments. My last bone marrow biopsy showed approximately 10 percent plasma cells with light chain restriction. The other lab tests are okay. Urine tests showed a slight abnormality – kappa free 31 and kappa/lambda ratio of 13 (normal 0.4 to 4.0). This is MGUS, correct? I am confused at what constitutes change to smoldering myeloma. Thank you for the clarification The key to your question depends on what is causing your anemia. MGUS is characterized by an M protein less than 3 g/dL, less than 10 percent plasma cells in the bone marrow, little or no Bence-Jones protein in the urine, no lytic lesions on bone survey and no evidence of kidney damage. Smoldering myeloma is characterized by an M protein of 3 g/dL or more, bone marrow plasma cells of 10 percent or more, and no evidence of bone lesions, significant anemia, hypercalcemia, or kidney damage. If your anemia can be explained by another cause, such as iron deficiency (as is suggested by the response of your blood counts to intravenous iron), you may be on the cusp between MGUS and smoldering myeloma based on the 10 percent plasma cells in your bone marrow. If, on the other hand, your anemia is related to the abnormal plasma cells in your bone marrow, you may have asymptomatic or perhaps symptomatic myeloma, depending on the severity of your anemia. Q3. My husband, who is 43, was diagnosed with IgG monoclonal gammopathy of unknown significance in July 2006. His M-spike has gone from 1.1 at diagnosis to 1.3 in January 2008 — a 21 percent increase. In September 2007, he had two unusual M-spike readings of 1.65 (a 41 percent increase from prior reading) and 1.51 two weeks later. What would cause those two unusually high readings? The doctor thought the first was just a lab error — but two errors in the same month? During this same time, his IgG count has gone down eight percent. I thought the IgG and M-spike would move in the same direction. Why would they move in opposite directions? The M-spike refers to an abnormal peak seen on a graph. The numerical value given to this peak may vary slightly depending on how one person interprets the graph compared to another person. The peak may also vary slightly from one reading to another depending on the body’s level of a normal protein called albumin on any given day. The IgG levelis the sum of the normal circulating immunoglobulin G and any abnormal circulating IgG produced as a result of the MGUS. Because one’s normal IgG level will fluctuate with the body’s response to environmental exposures like allergens and infections, the IgG level will not always track in the same direction as the M-spike, especially when variations in the M-spike are small. For these reasons, it is important that the trend of the M-protein and IgG be followed over time to assess the course of the monoclonal gammopathy. Q4. When I did some research on M protein and IgG together, I came up with POEMS. I have been diagnosed with MGUS (monoclonal gammopathy of unknown significance). Could I have been misdiagnosed? POEMS is an acronym for a rare syndrome whose main features are polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes/sclerotic bone lesions. To be diagnosed with POEMS, you must have both a monoclonal protein (M protein) and symptoms of polyneuropathy (dysfunction of multiple nerves). You must also have hardened bone lesions, Castleman’s disease (non-cancerous tumors in the lymph nodes), or high vascular endothelial growth factor levels. In addition, you must have organomegaly (enlarged liver, spleen or lymph nodes), extravascular volume overload (fluid accumulation in your legs, chest or abdominal cavities), an endocrinopathy (dysfunction of one or more hormone-producing glands), skin changes (such as hyperpigmentation or excessive hair growth), papilledema (swelling of the optic disc), an increased platelet count or an increased red blood cell count. MGUS, on the other hand, has three main criteria for diagnosis: M protein less than 3 grams per deciliter, bone marrow plasma cells less than 10 percent and no evidence of anemia, kidney failure or bone lesions. MGUS, which can develop into multiple myeloma, is much more common than POEMS. However, if you feel that you meet the criteria I described, you should discuss this with your oncologist. Q5. I was recently diagnosed with MGUS (monoclonal gammopathy of unknown significance). I am 78 years old and wonder how likely my condition will become full-blown multiple myeloma. MGUS is far more common than myeloma. Only a small fraction of people (1 percent per year) progress to develop myeloma from MGUS. However, having routine follow-up visits with your oncologist/hematologist to follow your MGUS is definitely a good idea to make sure myeloma is caught early if it does develop. Learn more in the Everyday Health Multiple Myeloma Center.
