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Have you been diagnosed with Monoclonal Gammopathy of Undetermined Significance? Are you experiencing bone pain, nerve pain and/or exhaustion? While monoclonal gammopathy of undermined significance (MGUS) is supposed to be “asymptomatic” meaning it does not come with symptoms, MGUS patients can experience a variety of health problems. Getting a blood clot can be serious.
MGUS at a glance-
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“In this issue of Blood, Kristinsson and colleagues report an increased risk of venous and arterial thrombosis in MGUS and multiple myeloma in a population-based study including 18 627 patients with multiple myeloma, 5326 patients with MGUS, and 70 991 controls.1…
Thrombosis usually is associated with disruptive symptoms, may lead to a postthrombotic syndrome, and can sometimes become life-threatening (see figure)…
In addition, several other new findings in the MGUS cohort are notable. Thrombosis in MGUS was associated with increased mortality but not with transformation to multiple myeloma. This indicates that the underlying premalignant process activates biological pathways, putting the affected person with MGUS and thrombosis at a higher risk for mortality…
Only patients with an IgG or IgA isotype, but not those with an IgM paraproteinemia, were at increased risk for thrombosis…
The risk for thrombosis was highest during the first year after diagnosis of MGUS, an observation reported for myeloma patients as well. The thrombotic risk reduction with further course of the disease is mainly due to better disease control after initiation of antimyeloma therapy.
However, this argument does not apply to MGUS patients as they are not receiving any disease-specific therapy. Which factor(s) then could account for the decline in thrombosis incidence even at 1 year after MGUS diagnosis? There are no convincing data providing an answer available as yet. It may be speculated that the underlying medical problems that motivate a patient to undergo clinical investigation increased the risk for thrombosis. Alternatively, the interaction between the monoclonal cell population and the host may be more intense shortly after initiation of the clonal plasma cell expansion. Thereafter, contra-regulatory mechanisms may dampen the stimulatory activity and thereby reduce, but not efface, the thrombotic risk.
Only patients with an IgG or IgA isotype, but not those with an IgM paraproteinemia, were at increased risk for thrombosis…”
“Several studies have shown that patients with multiple myeloma precursor disease (monoclonal gammopathy of undetermined significance [MGUS]) also have a higher risk of thrombosis compared to the general population…”
“Monoclonal gammopathy of undetermined significance (MGUS) has been proposed to be a risk factor for venous thromboembolic disease (VTE). However, no series published to date has been population-based or included a control group with similar comorbidities to people with MGUS…
Results: The VTE rate in the MGUS group was 2.2 per 100 person-years, which was not significantly different from the rate in the control group, 1.4 per 100 person-years. Most VTE events occurred within 4 months of the diagnosis of MGUS. In univariate analysis, albumin level (HR 0.21, CI 0.1-0.41, p<0.001), abnormal leukocyte count (HR 2.53, CI 1.09-5.86, p=0.03), and history of prior VTE (HR 4.41, CI 1.69-11.54, p=0.003) were associated with increased risk of VTE..
Conclusion: Our results suggest that the increased rate of VTE in people with MGUS may be primarily due to other underlying conditions that led to testing for a monoclonal gammopathy rather than to the monoclonal gammopathy itself.