How is MGUS monitored? How often should individuals diagnosd with MGUS have their myeloma blood markers retested? How often should individuals diagnosd with MGUS have repeat BMB and imaging?

How is MGUS monitored?

It's a very important point. The moment we know that the patient has MGUS, we know that we want to follow them very carefully. So it could be even once a year. That's it's okay to be that, you know, just once a year, come and see us. We'll talk about life. We'll talk about everything else. But we check the monoclonal protein, we check the light chains, and we potentially may look at other things, whether we need to do imaging of the bone, whether we need to do bone marrow biopsies in the future. But just a close observation. It's very important.

Well, Mayo Clinic I think, did a very interesting study that looked at patients with MGUS and were able to see for a breakdown. The patient was categorized into low risk, intermediate risk, and high risk. And the risk is for progression to full-blown myeloma. And patients who had an IgG subtype, small monoclonal protein, and normal free light chain ratio tend to have a very low risk of progression. These people may not need to be seen again or seen once a year, but if somebody has a very high monoclonal protein above 1.5g per deciliter, or they have an abnormal free light chain ratio, or some other monoclonal protein besides IgG, these are higher risk for progression. And maybe they need to be seen every 3 to 6 months.

The question is, do you always repeat the bone marrow or imaging study? And again, I think clinical judgment should play a role in that. So if the patient is having symptoms or if their hemoglobin went down, you know, becoming anemic, then obviously doing a bone marrow is important.