MGUS Diagnosis

a couple of years ago
/ Pre-Myeloma
/ By David Emerson
/ 8 COMMENTS

Monoclonal Gammopathy of Undetermined Significance is not cancer. MGUS is pre-cancer or a stage before full-blown multiple myeloma.

MGUS aka monoclonal gammopathy of undetermined significance is a diagnostic term for a “pre-cancer” stage of multiple myeloma. A diagnosis of MGUS increases your risk of developing multiple myeloma but it is not cancer.

Monoclonal gammopathy of undetermined significance (MGUS) is a double-edged sword. The good news is that you have caught a possible future incurable blood cancer early and may able to prevent your MGUS from becoming full-blown Multiple Myeloma for years if not for the rest of your life.

The bad news is that you will now spend the rest of your life worrying about your diagnosis of pre-Multiple Myeloma.

Your other challenge with a diagnosis of any form of pre-myeloma (SBP, MGUS, SMM) is that your oncologist will likely tell you that MGUS is asymptomatic and that your only option is to watch and wait. Fortunately there are evidence-based therapies shown to reduce your risk of a diagnosis of multiple myeloma.

And the key aspect of any pre-myeloma diagnosis is the degree of risk you face- high-risk, medium risk, low risk.

Conventional oncology classifies all pre-MM diagnoses- SBP, MGUS and SMM to be “blood disorders” and therefore offers no therapies to manage them other than a clinical trial or watch and wait.

When I was diagnosed with a form or pre-MM (a single bone plasmacytoma) my oncologist told me that nothing could be done. Yes, there was a small chance (3%) that my SBP would not become full MM but all I could do was to watch and wait.

I have been researching and writing about pre-myeloma for years. These posts discuss the key issues facing those diagnosed with MGUS as well as possible symptoms and therapies-

I am both a MM survivor and MM cancer coach. My experience and research have shown me that MGUS can be managed with evidence-based non-conventional therapies. I have worked with MGUS survivors who have been managing their pre-cancer for 15 years or more.

To learn more about the evidence-based protocols you can follow to prevent your Pre-Myeloma from becoming Multiple Myeloma, ask me a question or write a comment below.

Thank you,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Recommended Reading:

Diagnosis of monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic premalignant clonal plasma cell or lymphoplasmacytic proliferative disorder. It is defined by the presence of a serum monoclonal protein (M protein) at a concentration <3 g/dL, a bone marrow with <10 percent monoclonal plasma cells, and absence of end-organ damage (lytic bone lesions, anemia, hypercalcemia, renal insufficiency, hyperviscosity) related to the proliferative process.MGUS occurs in over 3 percent of the White population over the age of 50 and is typically detected as an incidental finding when patients undergo a protein electrophoresis as part of an evaluation for a wide variety of clinical symptoms and disorders (eg, peripheral neuropathy, vasculitis, hemolytic anemia, skin rashes, hypercalcemia, or elevated erythrocyte sedimentation rate).

There are three distinct clinical types of MGUS, each with a risk of progressing through a unique intermediate (more advanced) premalignant stage and then to a malignant plasma cell dyscrasia or lymphoproliferative disorder [1]:

●Non-IgM MGUS (IgG, IgA, or IgD MGUS) – Non-IgM MGUS is the most common subtype of MGUS and has the potential to progress to smoldering (asymptomatic) multiple myeloma and to symptomatic multiple myeloma. Less frequently, these patients progress to AL amyloidosis, light chain deposition disease, or another lymphoproliferative disorder.

●IgM MGUS – IgM MGUS accounts for approximately 15 percent of MGUS cases. It is considered separately from the non-IgM MGUS because it has the potential to progress to smoldering Waldenström macroglobulinemia and to symptomatic Waldenström macroglobulinemia, and less often to lymphoma or AL amyloidosis. Infrequently, IgM MGUS can progress to IgM multiple myeloma.

Multiple Myeloma

Dr. Stephen Cohen–Have you ever wanted to read the notes and observations of a practicing compassionate and empathetic doctor who has cared for cancer patients for over 40 years? Well, now you can! Dr. Stephen Cohen, a medical oncologist and hematologist practicing in San Antonio, Texas, has kept a daily journal of interesting medical info and tidbits he encounters day to day from his personal experiences with patient care, professional journals he reads, and medically relevant information on all subjects that he comes across.

Multiple Myeloma evolves from a monoclonal gammopathy of undetermined significance (MGUS).

Only 10% of patients with newly diagnosed myeloma have a history of pre-existing MGUS.

MGUS almost always precedes myeloma.

Smoldering myeloma is an intermediate stage between MGUS and myeloma is associated with a higher risk of progression of approximately 10% year.

MGUS arises from a premalignant proliferation of monoclonal plasma cells derived from post-germinal B cells, that undergo genetic and microenvironmental changes leading to the transformation of these cells into a malignant process.

MGUS is a disorder of the terminally differentiated B lymphocytes, called plasma cells.

Plasma cells secrete monoclonal immunoglobulin, IgG in about 60%, IgA in about 20%, for light chains in 20%, IgD in 2%, and OgM in 0.5%, and in about 2-3% no detectable M protein.

Recent diagnostic criteria have included specific biomarkers such as clonal bone marrow plasma cells equal or greater than 60%, serum free light chain ratio equals greater than 100, and one focal lesion on MRI imaging which was added to markers of end-stage organ damage- hypercalcemia renal insufficiency, anemia, or bone lesions.

At least 50% of patients with clonal plasma cell proliferation in monoclonal gammopathy of unknown significance (MGUS) translocations involving the immunoglobulin heavy chain (IgH) locus on chromosome 14q32 evolve into myeloma.

Willie Ratcliff says a few days ago

I was told by a cancer doctor that I had multiple myeloma and this doctor did a bone marrow biopsy so I went to a second doctor and he told me that I basically have what is called MGUS so I really don’t know which way to go this second doctor has scheduled me for a pet scan but what I have read is the bone marrow biopsy was the best way to find out the diagnosis thanks for your time and understanding

David Emerson says a few days ago

Hi Willie-

Yes, a diagnosis of MGUS, SMM and/or MM can be confusing. You are smart to get a second opinion. A bone marrow biopsy and a PET scan test for two different aspects of either MGUS or MM. A bone marrow biopsy (BMB) measures how many plasma cells (MM cells) are in your marrow and a PET scan looks for “bone involvement” or lesions that indicate bone problems. These tests are:

Bone marrow biopsy (percentage of plasma cells)
CRAB symptoms or end organ damage
Freelight chain ratio (kappa/lambda ratio)

Let me know if you have any questions.

Hang in there,

Both are important tests to try to figure out what is going on in your bone marrow.

As for MGUS vs. MM, there are several different markers (tests) that taken together, indicate MGUS or MM.

JM says 8 months ago

So from what I’m reading, my doc told me Waldenstroms- the pre MM info is pertinent to this also? I believe this is correct,altho my doc differentiated the two conditions- I’m still living life/diet in accord with the pre MM info that your course has provided- yes?

David Emerson says 8 months ago

Hi JM-

WM is similar to pre-mm yet has a much longer prognosis (see quote below). My guess is that your IgM is high. The only conventional therapies available for WM are chemo regimens. The pre-mm info and therapies are evidence-based, non-toxic therapies. Yes, keep undergoing diagnostics and at the same time, diet, exercise, etc. should help you manage your WM.

“How long can I live with Waldenstrom’s?
Recent studies suggest median survival rates closer to 14-16 years after diagnosis. This, plus the fact that people with WM tend to be older when diagnosed, puts their survival rates closer to those expected for the general population.”

Let me know if you have any other questions JM.

Patricia Downing says last year

Hi David–thank you for coming to my rescue on FB. I guess I’m suffering from a tiny teeny bit of anxiety and all this is daunting. I couldn’t even figure out how to sign up for your course after watching your video. I have a question: 1.you mentioned there are 3 types of MGUS–are you able to tell me which cancer mine would lead me to? IgM 21.14 Kappa—-IgG 6.3 normal–IgA Low @ 0.62 2. I have nummular exema wanting to surface after many yrs. of being dormant(I thought I had detoxed it out of my system) would this surfacing again be caused by MGUS? Thanks David–

David Emerson says last year

Hi Patricia-

I replied to this email earlier today and sent it to your email in box- check your spam folder if you didn’t receive it- let me know if you have any questions.

Amy Bissell says last year

I am interested in more information on treating MGUS

Hi Amy-

You will be able to learn a great deal about MGUS by taking the Pre-MM CC course. Let me know if you have any questions.

Thanks,

Diagnosed with SMM, SPB, or MGUS?

MGUS Diagnosis

Monoclonal Gammopathy of Undetermined Significance is not cancer. MGUS is pre-cancer or a stage before full-blown multiple myeloma.

Recommended Reading:

Diagnosis of monoclonal gammopathy of undetermined significance

Multiple Myeloma

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