How often should individuals diagnosed with MGUS have their myeloma markers retested?

[Music] how often should individuals diagnosed with M gusts have their myeloma markers retested there's more and more research in this area and so we're better at dividing up who has em Gus so let's start with em Gus so that's that situation where again a large amount of the population if you start testing people will have monoclonal protein so the estimate is three to five percent of a middle-aged population in ten percent of people who are eighty will have these Monica proteins so there has been some research trying to decide who is more likely to go on to develop myeloma so part of that is related to how high that monoclonal protein is so if it is under 1.5 grams per deciliter patients are very unlikely to go on to develop myeloma if they have a low light chain level and again that number you know under eight those patients seem less likely to go on to develop myeloma if they have one of the other features is does that bone marrow biopsy show a low number of plasma cells so to have them Gus typically you have greater than 5 out of 100 cells or plasma cells the other thing that can be associated with changes are what type of protein you have so for reasons we don't understand if your M Gus is IgG Kappa you actually have a lower risk of risk of progression to myeloma than if you had an IgA or a iga land those those types of proteins are assessing with a higher risk of progression so for people who have low monoclonal protein low ratio the chances of progression per year are very low about 1% and once we're pretty sure that's the features that somebody has usually the follow-up can be about annually and it can also be done by a primary care person there is very interesting data that says even if you're in that low risk it's still probably a good idea for you check up on that so we would say that you should never have follow you shouldn't not just double negative but you should not never have followed but you could do it annually would be fine so for people who have over 1.5 grams per deciliter of monoclonal protein what we try to do first is to establish whether or not they have smoldering myeloma and I'll get back to the difference here so assuming that they don't meet that definition or besides that higher level of monoclonal protein they do have a higher ratio and have fewer than 10% plasma cells in their bone marrow or they have an IgA monoclonal protein most people would say those patients we might want to follow them say every six months it seems like they have a higher risk of progression than a person with lower protein levels so we do want to see them but they are a different group than what we call smoldering [Music]