Table 2. Risk-stratified management of... | American Society of Hematology

Table 2.

Risk-stratified management of MGUS patients

All MGUS patients	Risk stratification		Classification	Additional evaluation at diagnosis	Monitoring and evaluation
SPEP, CBC, creatinine	Risk factors for progression³:	0 risk factors	Low risk	No additional testing required	Repeat SPEP, CBC, and creatinine in 6 mo and then every 2-3 y if stable, or when symptoms of progression arise
	• M-protein, >1.5 g/dL	1 risk factor	Low-intermediate risk	LDH B2-macroglobulin Bone marrow biopsy with FISH IgM MGUS → CT chest and abdomen to evaluate for lymphadenopathy Non-IgM MGUS → skeletal assessment† Light-chain MGUS → NTproBNP, cardiac troponins, urine albumin	If additional testing negative → SPEP, CBC, and creatinine in 6 mo then annually for life if remains stable* If signs of progression → decrease follow-up interval and initiate workup for lymphoplasmacytic malignancy
	• Non-IgG paraprotein (IgA or IgM)	2 risk factors	High-intermediate risk
	• FLC ratio, <0.26 or >1.65	3 risk factors	High risk

All MGUS patients	Risk stratification		Classification	Additional evaluation at diagnosis	Monitoring and evaluation
SPEP, CBC, creatinine	Risk factors for progression³:	0 risk factors	Low risk	No additional testing required	Repeat SPEP, CBC, and creatinine in 6 mo and then every 2-3 y if stable, or when symptoms of progression arise
	• M-protein, >1.5 g/dL	1 risk factor	Low-intermediate risk	LDH B2-macroglobulin Bone marrow biopsy with FISH IgM MGUS → CT chest and abdomen to evaluate for lymphadenopathy Non-IgM MGUS → skeletal assessment† Light-chain MGUS → NTproBNP, cardiac troponins, urine albumin	If additional testing negative → SPEP, CBC, and creatinine in 6 mo then annually for life if remains stable* If signs of progression → decrease follow-up interval and initiate workup for lymphoplasmacytic malignancy
	• Non-IgG paraprotein (IgA or IgM)	2 risk factors	High-intermediate risk
	• FLC ratio, <0.26 or >1.65	3 risk factors	High risk

CBC, complete blood count; FISH, fluorescence in situ hybridization; LDH, lactate dehydrogenase.

Include NTproBNP, cardiac troponins, and urine albumin for light-chain disease.

Low-dose CT preferred.