Monoclonal gammopathy of undetermined significance diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]
Overview
There is no single gold standard test for the diagnosis of monoclonal gammopathy of undetermined significance. Bone marrow aspiration and biopsy is done in all patients having M-protein level ≥1.5 g/dL. Diagnostic criteria depends on the type of monoclonal gammopathy like non-IgM, IgM, or light chain gammopathy. The criteria includes serum monoclonal proteins, plasma cells in the marrow and absence of systemic signs.
Study of choice
There is no single gold standard test for the diagnosis of monoclonal gammopathy of undetermined significance. Bone marrow aspiration and biopsy is done in all patients having M-protein level ≥1.5 g/dL.
Diagnostic Criteria
Non-IgM MGUS (IgG, IgA, or IgD MGUS) is diagnosed on the basis of the following three criteria
- Serum monoclonal protein (M-protein, whether IgA, IgG, or IgD) level <3 g/dL.
- Less than 10 percent clonal plasma cells in marrow.
- Absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the plasma cell disorder.
IgM MGUS is diagnosed on the basis of the following three criteria[1][2][3]
- Serum monoclonal protein (M-protein, whether IgA, IgG, or IgD) levels <3 g/dL.[4]
- Fewer than 10 percent clonal lymphoplasmacytic/plasma cells in the marrow.
- Absence of end-organ damage such as anemia, constitutional symptoms, hyperviscosity, lymphadenopathy, or hepatosplenomegaly related to the plasma cell disorder
Light chain MGUS (LC-MGUS) is diagnosed on the basis of the following three criteria[2]
- Abnormal FLC ratio (ie, ratio of kappa to lambda FLCs <0.26 or >1.65)
- Increased level of light chain (eg, increased kappa FLC with a ratio >1.65 and increased lambda FLC with a ratio <0.26)
- No monoclonal immunoglobulin heavy chain (IgG, IgA, IgD, or IgM)
- Fewer than 10 percent clonal lymphoplasmacytic cells in the marrow
- Absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the plasma cell disorders
References
- ↑ "Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group". Br. J. Haematol. 121 (5): 749–57. June 2003. PMID 12780789.
- ↑ 2.0 2.1 Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF (November 2014). "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma". Lancet Oncol. 15 (12): e538–48. doi:10.1016/S1470-2045(14)70442-5. PMID 25439696.
- ↑ Kyle RA (May 1978). "Monoclonal gammopathy of undetermined significance. Natural history in 241 cases". Am. J. Med. 64 (5): 814–26. PMID 645746.
- ↑ Kyle RA (November 1994). "The monoclonal gammopathies". Clin. Chem. 40 (11 Pt 2): 2154–61. PMID 7955402.