What are the potential complications of MGUS that I should be aware of during routine patient assessments?

Monoclonal gammopathy of undetermined significance (MGUS) is generally asymptomatic but carries potential complications that should be monitored during routine patient assessments. The primary concern is progression to multiple myeloma or related plasma cell disorders, which occurs at an approximate rate of 1% per year. This progression risk necessitates vigilance for symptoms such as bone pain, anemia, renal impairment, hypercalcemia, and infections, which may indicate transformation to symptomatic myeloma or other malignancies NICE NG35 Kyle et al. 2010Landgren 2010.

Additionally, MGUS can be associated with bone disease, including osteoporosis and fragility fractures, even before progression to myeloma. Patients may present with skeletal complications due to underlying bone remodeling abnormalities, so assessment of bone health and fracture risk is important during follow-up NICE NG35 Nador et al. 2019.

Renal dysfunction is another potential complication, as monoclonal proteins can cause kidney damage either directly or through deposition diseases. Routine monitoring of renal function is advised to detect early impairment NICE NG35 Kyle et al. 2010.

Other less common but clinically relevant complications include peripheral neuropathy and immunosuppression leading to increased infection risk, which may arise from the monoclonal protein or evolving plasma cell disorder NICE NG35 Kyle et al. 2010.

In summary, during routine assessments of patients with MGUS, clinicians should be alert to signs of progression to myeloma, bone disease including fractures, renal impairment, neuropathy, and infections. Regular monitoring with clinical evaluation and laboratory tests such as serum protein electrophoresis, serum-free light-chain assay, renal function, and bone profile is recommended to identify these complications early NICE NG35 Kyle et al. 2010Landgren 2010Nador et al. 2019.