Prevalence of Monoclonal Gammopathy of Undetermined Significance in a Large Population with Annual Physical Examination in Beijing, China

Introduction Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic premalignant plasma cell disorder. Previous studies in Western countries have described the prevalence of MGUS in Caucasians. However, data is limited in Chinese population. We therefore performed this study to ascertain the prevalence and characteristics of MGUS among Chinese population. Methods A total of 154597 consecutive healthy participants from Beijing who underwent annual physical examination between December 2013 and April 2019 at Peking Union Medical College Hospital were enrolled. Serum M protein was evaluated by capillary electrophoresis. Patients with a positive or suspicious serum M protein were suggested to be referred to the hematological clinic for immunofixation electrophoresis (IFE) and free light chain (FLC) assays. MGUS was defined in accordance with previous definitions. We calculated age-specific and sex-specific prevalence and described laboratory characteristics of patients with MGUS among those participants. Results MGUS were diagnosed in 843 patients (0.55%, 95%CI 0.51% to 0.59%). The median age at presentation was 58 years, with a range of 25-96 years. The overall prevalence of MGUS was 1.14% among participants aged 50 years or older and 2.6% among those aged 70 years or older. In both sexes, the prevalence increased with age: 0.1% (<40 years), 0.36% (40-49 years), 0.78% (50-59 years), 1.28% (60-69 years), 2.19% (70-79 years), and 3.77% (≥80 years) separately (Figure 1). The prevalence among men were higher than that among women (0.67% vs. 0.40%, OR =1.719, 95% CI 1.490 to 1.983, P<0.001) (Figure 1). The median concentration of serum Monoclonal protein was 1.4 g/L (0.1 -27.8 g/L). M protein level was less than 0.5g/L in 220 patients (26.1%), less than 5 g/L in 81.1% and more than 15 g/L in only 1.9% of 843 persons. There was no significant difference in the concentration of the monoclonal protein among the age groups. Of the 519 patients who were tested for IFE, the isotype of the monoclonal immunoglobulin was IgG in 344 (66.3%), IgA 112 (21.6%), IgM in 48 (9.2%), IgD in 2 (0.4%), light-chain in 3 (0.6%) and biclonal in 10 (1.9%). The serum light-chain type was kappa in 260 (50.1%), lambda in 255 (49.1%) patients, while 4 patients (0.8%) with biclonal M protein have both kappa and lambda light-chain. Of the 180 people who were tested for FLC, 42 (23.3%) had an abnormal FLC ratio. IgG isotype, M protein <15 g/L and normal FLC ratio were found in 102 patients (56.7%) and the remaining 78 people (43.4%) had 1(30.6%) or 2(12.8%) abnormal factors. Conclusions MGUS was found in 1.14% of persons 50 years of age or older and 2.6% among those 70 years of age or older among healthy Chinese population. The prevalence of MGUS increases with age. Males have a higher frequency of MGUS than Females. These observations offer the overall situation of MGUS epidemiology in a large Chinese population. Disclosures No relevant conflicts of interest to declare.

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Bone Marrow Biopsy May Be Required During the Initial Evaluation of Individuals with Asymptomatic Monoclonal Gammopathy

Blood ◽

10.1182/blood.v118.21.5067.5067 ◽

2011 ◽

Vol 118 (21) ◽

pp. 5067-5067

Author(s):

Meletios Athanasios Dimopoulos ◽

Evangelos Terpos ◽

Maria Gkotzamanidou ◽

Evangelos Eleutherakis-Papaiakovou ◽

Magdalini Migkou ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Plasma Cell ◽

Light Chain ◽

Monoclonal Gammopathy ◽

Plasma Cells ◽

Conflicts Of Interest ◽

Incidental Finding ◽

M Protein ◽

Monoclonal Protein

Abstract Abstract 5067 The incidental finding of a monoclonal gammopathy during workup for various conditions or in the context of a routine check-up is increasingly common. Several “patients” are then referred for diagnostic evaluation of their monoclonal gammopathy and additional workup is needed. It has been proposed that a bone marrow (BM) aspirate and biopsy is indicated when the monoclonal protein (M-protein) is ≥1.5 g/dL, when abnormalities are noted in the complete blood cell count, serum creatinine level, serum calcium level, or radiographic bone survey, in individuals with non-IgG monoclonal gammopathy and in those with an abnormal serum free light chain (FLC) ratio. The aim of this study was to identify factors that could aid in the evaluation of individuals presenting with asymptomatic monoclonal gammopathy and in whom invasive diagnostic testing with a bone marrow biopsy is considered. Thus, we analyzed our database and identified patients who were referred to the Department of Clinical Therapeutics of the University of Athens, Greece, for evaluation of asymptomatic monoclonal gammopathy and in whom a BM trephine biopsy, a serum and urine protein electrophoresis (SPEP) with immunofixation and quantitative immunoglobulins were performed. SPEPs were scanned and M-protein was measured using imaging analysis software. Patients with a monoclonal M-protein ≥ 3 g/dl (30 g/L), i.e. those diagnosed with asymptomatic/smoldering myeloma (SMM) or Waldenstrom's macorglobulinemia based on the standard criteria, were not included in the analysis. Clonality of BM plasma cells or lymphoplasmacytes was assessed by immunohistochemistry. Patients who eventually were diagnosed with plasma cell related conditions (i.e. amyloidosis, peripheral neuropathy, dermatoses, etc.) were also excluded from the analysis. Our analysis included 161 patients: 53% were females, median age was 64 year (range 33–89 years), 53% had a monoclonal IgG protein, 15.5% had a monoclonal IgA protein, 24% a monoclonal IgM protein and 2.5% had only a monoclonal light chain, while 4% had a biclonal protein. In 64% of patients the monoclonal light chain was kappa and in 37% was lambda. The median serum M-protein was 0.948 g/dl (range 0.1–2.99 g/dl); 52% of patients had an M-protein of <1 g/dl and 79% of <2 g/dl. Immunoparesis of at least one of the uninvolved immunoglobulins was present in 38% of cases and of both of the uninvolved immunoglobulins in 6%. Median BM infiltration by monoclonal plasma cells or lymphoplasmacytes was 15%. In 66.5% of individuals there was a BM infiltration of ≥10% by monoclonal plasma cells or lymphoplasmacytes, while in 10% of the studied cases the BM infiltration was ≥50%. A significant correlation of the size of M-protein and of the infiltration of the BM was found (R=0.592, p<0.001). However, 27% of patients with M-protein <0.5 g/dl had ≥10% clonal plasma cells or lymphoplasmacytes in their BM biopsies. The respective rates were 46% for those with M-protein <1 g/dl, 54% for those with M-protein 1.5 g/dl and 58% for those with M-protein <2 g/dl. Ninety per cent of those who had immunoparesis of at least one of the uninvolved immunoglobulins had ≥10% clonal plasma cells or lymphoplasmacytes. A BM infiltration of ≥10% was more frequent in individuals with a monoclonal IgG or IgA protein (72% and 80%, respectively) vs. 45% of those with a monoclonal IgM protein (p=0.015). Light chain isotype, age and gender were not predictive of the degree of BM plasma cell infiltration. In multivariate analysis, immunoparesis of at least one of the uninvolved immunoglobulins (OR: 6.45, 95% CI: 2.32–18, p<0.001), an IgG or IgA monoclonal protein (OR: 2.67, 95% CI: 1.1–6.4, p=0.028) and an M-protein of ≥1 g/dl (OR: 5.4, 95% CI: 2.23–13) were independently associated with the presence of ≥10% of clonal infiltration in BM biopsy. By combining the above risk factors we found that in those who had all three, 97% had ≥10% clonal cells in the BM biopsy, while in those with 0–1 of the above factors the probability to find ≥10% clonal cells was 43%. These findings indicate that even patients with low risk for BM infiltration by clonal plasma cells, may be diagnosed as SMM when a BM biopsy is performed. In conclusion, our data on a large number of individuals with asymptomatic monoclonal gammopathy who underwent a BM biopsy may indicate that the latter exam may provide useful information and could be included in the standard initial workup of these individuals. Disclosures: No relevant conflicts of interest to declare.

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The predictive power of serum κ/λ ratios for discrimination between monoclonal gammopathy of undetermined significance and multiple myeloma

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2005.004 ◽

2005 ◽

Vol 43 (1) ◽

Cited By ~ 3

Author(s):

Enrique Bergón ◽

Elena Miravalles ◽

Elena Bergón ◽

Isabel Miranda ◽

Marta Bergón

Keyword(s):

Multiple Myeloma ◽

Predictive Value ◽

Monoclonal Gammopathy ◽

Predictive Power ◽

Protein Detection ◽

M Protein ◽

Likelihood Ratios ◽

Geographic Population ◽

Significant Difference ◽

Undetermined Significance

AbstractThe predictive power of serum κ/λ ratios on initial presentation of immunoglobulin G (IgG) or IgA monoclonal component was studied to differentiate between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) patients. The retrospective study involved 145 patients clinically diagnosed with monoclonal gammopathy of undetermined significance or multiple myeloma, who had serum M-protein IgG <35g/L or IgA <20g/L at M-protein detection. Serum light chains κ and λ were measured by fixed-time nephelometry. Test performance indices, predictive values and likelihood ratios were calculated according to the Weissler recommendation. MM patients were considered as diseased and MGUS patients as non-diseased in order to estimate the performance characteristics of serum κ/λ ratios. There was a statistically significant difference in κ/λ ratios distribution between both groups of patients, in both M-protein κ-type (Mann-Whitney U=168, p<0.001) and in M-protein λ-type (Mann-Whitney U=143, p<0.001). Negative likelihood ratios at threshold levels of 0.6 and 4.2 were 2.17- and 3.32-fold greater, respectively, than positive likelihood ratios, so that the predictive power of a serum κ/λ ratio within these limits is better in ruling out (negative predictive power) than ruling in disease (positive predictive power). The post-test characteristics of a serum κ/λ ratio interval between 0.6 and 4.2 in discriminating MGUS from MM in our geographic population were: sensitivity 0.96 (0.93–0.99 95%CI); specificity 0.70 (0.63–0.77); positive predictive value 0.68 (0.64–0.73); negative predictive value 0.96 (0.94–0.99); likelihood ratios (+)LR 3.23 (2.68–4.04); and (−)LR 17.16 (11.00–63.00). Thus, serum M-protein with a κ/λ ratio between 0.6 and 4.2 increases the posterior probability of MGUS from 0.60 to 0.96 in asymptomatic patients, for whom only monitoring may be suggested when the serum κ/λ ratio is within these limits.

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Monoclonal gammopathy of undetermined significance and risk of lymphoid and myeloid malignancies: 728 cases followed up to 30 years in Sweden

Blood ◽

10.1182/blood-2013-05-505487 ◽

2014 ◽

Vol 123 (3) ◽

pp. 338-345 ◽

Cited By ~ 63

Author(s):

Ingemar Turesson ◽

Stephanie A. Kovalchik ◽

Ruth M. Pfeiffer ◽

Sigurdur Y. Kristinsson ◽

Lynn R. Goldin ◽

...

Keyword(s):

Light Chain ◽

Monoclonal Gammopathy ◽

Protein Concentration ◽

Free Light Chain ◽

M Protein ◽

Myeloid Malignancies ◽

Lymphoid Malignancies ◽

Key Points ◽

Undetermined Significance

Key Points Free light chain ratio, M-protein concentration, and immunosuppression predict progression of MGUS to lymphoid malignancies.

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Five years’ Follow-Up Study For Frequency Of Monoclonal Gammopathy Of Undetermined Significance (MGUS) In a Korean Elderly Urban Cohort

Blood ◽

10.1182/blood.v122.21.5332.5332 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5332-5332

Author(s):

Yun-Gyoo Lee ◽

Soo-Mee Bang ◽

Jeong-Ok Lee ◽

Song Jung Han ◽

Kim Ki Woong ◽

...

Keyword(s):

Multiple Myeloma ◽

Monoclonal Gammopathy ◽

M Protein ◽

Risk Of Death ◽

Follow Up Study ◽

Significant Difference ◽

Korean Elderly ◽

Second Wave ◽

Undetermined Significance

Abstract Background The prevalence of monoclonal gammopathy of undetermined significance (MGUS) increases with patient age and varies by race. However, reliable data on the epidemiology of MGUS is limited in Korea. We previously reported the prevalence of MGUS among 1000 participants of a Korean Elderly Urban Cohort recruited from 2005 to 2006 (First Wave, Park HK Am J Hematol. 2011;86:752-5); age and gender-adjusted prevalence of MGUS was estimated as 3.3% (95% confidence interval [CI] = 2.0-4.6%). Here, we report the five years’ follow-up study for frequency of MGUS between 2010 and 2011. Methods Korean Longitudinal Study on Health and Aging (KLoSHA) is a population-based, prospective cohort study of health, aging, and common geriatric diseases in a population aged ≥ 65 years in Seongnam-si, a satellite city of Seoul. Of the random sample of 1118 candidates from 61,730 Korean elderly individuals, 698 respondents agreed to participate in baseline KLoSHA study between 2005 and 2006. A total of 680 with available samples were screened for MGUS. We followed them and collected their serum between 2010 and 2011 (Second Wave). The screening of MGUS in the Second Wave was performed using serum protein electrophoresis followed by immunofixation assays; MGUS was defined by the presence of a serum monoclonal protein (M-protein), at a concentration <3 g/dL, and in the absence of end organ damage. Bone marrow study was not performed unless the patient was suspicious of multiple myeloma. To validate complete follow-up data, information regarding vital status was obtained from the National Population Registry of Korea National Statistical Office by using a unique resident registration number. Overall survival was calculated from the date of First wave to death from any cause. Results Of the 680 respondents (21 with MGUS, 659 without MGUS) in the First Wave, 361 (53%) agreed to participate in the Second Wave. Causes of nonattendance were death in 20%, refusal in 19%, move to other area in 6%, and loss to contact in 3%. Of the 361 respondents, 10 were identified to have MGUS. Overall frequency of MGUS is 2.8% (95% CI: 1.3 - 5.0%). Among 21 patients with MGUS in the First Wave, 9 were followed up in the Second Wave. Six of them showed persistent MGUS. One of them showed mild anemia with persistent M-protein of 1.4g/dL suggestive of progression to multiple myeloma, but was not confirmed because of early death just after screening. Interestingly, M-protein was disappeared in remaining 2 patients with MGUS in the First wave. Among 659 respondents without MGUS in the First Wave, 352 were followed up in the Second Wave. Four of them were newly diagnosed with MGUS. In Kaplan-Meier survival analysis, there was no significant difference of survival between respondents with MGUS and without MGUS in the First Wave (P = 0.66 by Log-rank test). Conclusion Five years’ follow-up data showed the natural clinical course of MGUS. The diagnosis of MGUS was not associated with an increased risk of death in Korean elderly population. The interesting finding was that M-protein was disappeared in some patients with MGUS. High rate of non-attendance (47%) in Second Wave is the major limitation. Disclosures: No relevant conflicts of interest to declare.

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Hepatitis B Associated Monoclonal Gammopathy That Resolved after Successful Liver Transplant

Journal of Transplantation ◽

10.1155/2009/103784 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3

Author(s):

P. Sreenivasan ◽

S. Nair

Keyword(s):

Multiple Myeloma ◽

Liver Transplantation ◽

Hepatitis B ◽

Light Chain ◽

Monoclonal Gammopathy ◽

Lymphoproliferative Disorders ◽

M Protein ◽

Kappa Light Chain ◽

Hepatitis B Infection ◽

Undetermined Significance

Monoclonal gammopathy of undetermined significance (MGUS) has been most commonly associated with diseases like multiple myeloma, Waldenstrom's macroglobulinemia, primary systemic amyloidosis, HIV, and other lymphoproliferative disorders. There has been an isolated report of MGUS in patients coinfected with HIV and Hepatitis B, as the work by Amara et al. in 2006. Here, we report a case of IgA-kappa light chain gammopathy secondary to Hepatitis B infection, which resolved after liver transplantation. To our knowledge, this is the first reported case of M protein spike seen in the context of Hepatitis B infection only.

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Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance

Blood ◽

10.1182/blood-2005-03-1038 ◽

2005 ◽

Vol 106 (3) ◽

pp. 812-817 ◽

Cited By ~ 405

Author(s):

S. Vincent Rajkumar ◽

Robert A. Kyle ◽

Terry M. Therneau ◽

L. Joseph Melton ◽

Arthur R. Bradwell ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Light Chain ◽

Monoclonal Gammopathy ◽

M Protein ◽

Intermediate Risk ◽

Serum Free ◽

Serum Free Light Chain ◽

Risk Of Progression ◽

Undetermined Significance

AbstractWe hypothesized that the presence of monoclonal free kappa or lambda immunoglobulin light chains in monoclonal gammopathy of undetermined significance (MGUS), as detected by the serum free light chain (FLC) assay increases the risk of progression to malignancy. Of 1384 patients with MGUS from Southeastern Minnesota seen at the Mayo Clinic from 1960 to 1994, baseline serum samples obtained within 30 days of diagnosis were available in 1148. At a median follow-up of 15 years, malignant progression had occurred in 87 (7.6%) patients. An abnormal FLC ratio (kappa-lambda ratio < 0.26 or > 1.65) was detected in 379 (33%) patients. The risk of progression in patients with an abnormal FLC ratio was significantly higher compared with patients with a normal ratio (hazard ratio, 3.5; 95% confidence interval [CI], 2.3-5.5; P < .001) and was independent of the size and type of the serum monoclonal (M) protein. Patients with an abnormal serum FLC ratio, non–immunoglobulin G (non-IgG) MGUS, and a high serum M protein level (≥ 15 g/L) had a risk of progression at 20 years of 58% (high-risk MGUS) versus 37% with any 2 of these risk factors (high-intermediate risk), 21% with one risk factor (low-intermediate risk), and 5% when none of the risk factors were present (low risk).

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Abnormal Heavy/Light Chain Ratio after Treatment Is a Robust Predictor of Shorter Survival in Patients with IgA Myeloma

Blood ◽

10.1182/blood.v128.22.3254.3254 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3254-3254

Author(s):

Yoshiaki Abe ◽

Yasuhito Suehara ◽

Hiroyuki Takamatsu ◽

Yoshiaki Usui ◽

Kentaro Narita ◽

...

Keyword(s):

Overall Survival ◽

Serum Protein ◽

Light Chain ◽

Protein Electrophoresis ◽

Serum Protein Electrophoresis ◽

M Protein ◽

Lower Sensitivity ◽

Prognostic Impact ◽

Monoclonal Protein ◽

Significant Difference

Abstract Accurate quantification of monoclonal protein (M-protein) is essential for response assessment, management, and prediction of prognosis in patients with multiple myeloma (MM). Serum protein electrophoresis (SPEP) is commonly used to determine the degree of M-protein reduction in intact immunoglobulin (Ig) MM. However, SPEP has limitations when M-protein comigrates into the beta-fraction or M-protein fails to show a distinct sharp spike on densitometry. Ig heavy/light chain (HLC) assay enables separate quantification of the different light chain types of each Ig class. Although HLC assay quantifies different light chain subtypes of Ig classes, the sensitivity for detecting M-protein clonality and its impact on outcome may differ between IgA and IgG myeloma. To investigate the clinical and prognostic impact of HLC assay, we retrospectively analyzed the correlation of heavy/light chain ratio (HLCR) with clinical status and its impact on outcome. A total of 402 frozen serum samples from 120 patients with MM (41 for IgA and 79 for IgG) treated at Kameda Medical Center (Kamogawa-shi, Chiba, Japan) and Kanazawa University Hospital (Kanazawa-shi, Ishikawa, Japan) at the times of various IMWG responses were collected. Samples were analyzed using the HLC assay, and the results were compared with serum protein electrophoresis (SPEP), free light chain ratio (FLCR), immunofixation, total IgG, IgA, and overall survival (OS). Percentages of samples with normal HLCR at presentation, PR, VGPR, CR, and sCR were 0%, 0%, 27.6%, 100%, and 88.9%, respectively, for IgA MM and 0%, 12.5%, 64.3%, 100%, and 84.3%, respectively, for IgG MM. Normalization of HLCR at VGPR was more frequent in IgG MM compared to IgA MM (PR; 12.5% vs. 0%, respectively, P = 0.169, VGPR; 64.3% vs. 27.6%, respectively, P = 0.004), which suggests the lower sensitivity of detecting clonality in patients with IgG MM than those with IgA MM. Abnormal HLCR was seen more frequently in patients with poorer myeloma response, and it appeared to be more sensitive for detecting clonality in IgA myeloma compared to IgG myeloma after treatment. No significant difference in OS was observed between patients with or without uninvolved Ig suppression and OS if they obtained ≥ VGPR. Among the 85 patients that achieved ≥ VGPR, those that remained HLCR abnormal showed significantly shorter overall survival (OS) compared to those achieving normal HLCR (not reached vs. 55.5 months, P = 0.032). This correlation was seen in IgA myeloma patients (not reached vs. 30.1 months, P = 0.014), but not in IgG myeloma patients when analyzed separately. Univariate and multivariate analyses of factors that may affect survival identified abnormal HLCR at the best response as the only independent risk factor (hazard ratio, 4.7; 95% confidence interval, 1.4 - 15.26; P = 0.012) for shorter OS in this subset of patients. In conclusion, HLC assay is useful for accurate monitoring of monoclonal protein in patients with myeloma. The results suggested that obtaining normal HLCR indicated a more favorable prognosis in patients with IgA myeloma, but not IgG myeloma, that achieved VGPR or better response. Disclosures Takamatsu: Celgene: Honoraria; Janssen Pharmaceuticals: Honoraria.

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Monoclonal Gammopathies: Electronic Subspecialty Consultation

Blood ◽

10.1182/blood.v130.suppl_1.673.673 ◽

2017 ◽

Vol 130 (Suppl_1) ◽

pp. 673-673

Author(s):

Nicholas Burwick ◽

Jacob Stein ◽

David A Garcia ◽

Virginia C. Broudy ◽

Robert E. Richard

Keyword(s):

Risk Stratification ◽

Light Chain ◽

Monoclonal Gammopathy ◽

Free Light Chain ◽

Low Risk ◽

M Protein ◽

Monoclonal Protein ◽

Face To Face ◽

Electronic Consultation

Abstract Introduction : Non-visit electronic consultation (e-consult) is an important component of care for veterans in the VA healthcare system who require sub-specialty consultation but not urgent face to face evaluation. Since the majority of patients with monoclonal gammopathy of undetermined significance (MGUS) are low-risk of disease transformation, we reasoned that e-consult would be a safe and effective way to manage MGUS in most cases. Here we sought to characterize our current e-consult practice patterns for the surveillance of MGUS and identify key questions for future investigation. Methods : We performed a retrospective analysis of our electronic consult database from 1/1/2010-12/31/2014 to identify cases of monoclonal gammopathy. Monoclonal gammopathy was confirmed on chart review by an attending hematologist. To be included in the analysis, a patient had to have either 1) a monoclonal protein by serum or urine protein electrophoresis (SPEP/UPEP) or immunofixation or 2) abnormal serum free light chain (FLC) ratio, using a normal reference range of 0.26-1.65, with an increase in the involved light chain. Pertinent clinical and demographic data was abstracted and was used to analyze outcomes among the cohort. Results : We screened 3,217 electronic hematology consults to identify a cohort of 152 MGUS patients triaged for e-consult over a five-year period. E-consult services were provided for veterans from 23 different counties with an average time to completion of 3.4 days. The average size of monoclonal (M) protein was 0.25 g/dL (0-1.5 g/dL). 84% of patients had an M-protein concentration less than 0.5 g/dL. Following completion of risk-stratification studies, 113/121 (93%) of patients with available risk scores were lower risk for disease progression (0-1 risk factors). There were 11 cases with negative SPEP for whom a risk score could not be calculated. An additional 20 cases had a positive SPEP without available free light chain data. A minority of patients (29%) had FLC data available at the time of consult. At 3-months post-consult, 71% had completed FLC testing. One-third of patients had an abnormal hemoglobin (hgb) and 41% had an abnormal creatinine (cr) using the normal reference ranges. However, 96% of MGUS e-consults had a hgb >10 g/dL and 90% had a cr <2 mg/dL. Among those tested (n=91), one patient had skeletal abnormalities concerning for myelomatous bone disease on initial screening. One-third of cases utilized multiple e-consult encounters over time, while 15% of MGUS e-consults ultimately required a face-to-face visit with hematology. With an average follow-up of 47 months (median 44 months), there were 6 documented progression events, representing a mean rate of progression of 1% per year (Figure). Conclusions : We find that electronic consultation is a helpful mechanism for evaluating MGUS longitudinally, decreasing travel burden, and improving timely access to care for veterans. The majority of MGUS cases triaged for e-consult at our center are low-risk by established criteria and have very low amounts of monoclonal protein. Most of these patients can be followed with routine paraprotein surveillance and deferred skeletal imaging. Timely completion of biomarker studies is critical for appropriate risk-stratification and triage. The use of additional system tools (such as task trackers) to assist with follow-up of outstanding tests may help augment services provided electronically. These observations may be generalizable to other VA centers and other health-care systems where e-consult is becoming more widely adopted. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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