Monoclonal gammopathy of unknown sugificant(MGUS): Is a radiologic search for an associated lymphoma justified? – pro

Monoclonal gammopathy is a condition that can progress to multiple myeloma bit is sometimes is associated with the presence of lymphoma. Some physicans consider this association to be sufficient to justify a search for lymphoma with CT or PET scans. However, there is insufficient evidence to justify imaging screening for lymphoma. Even screening and followup for associated myeloma, which is much more common, is not generally productive, at least in low risk MGUS patients, as recently reported by Bianchi et al. BJH Best Practice only recommends CT screening for patients with an IgM monoclonal protenin with levels of 10g/l or igher. It and other guidelines recommend skeltal survey as the only imaging study for workup of patients with MGUS.

Katzmann JA, Kyle RA, Benson J, et al. Screening panels for detection of monoclonal gammopathies. Clin Chem. Aug 2009;55(8):1517-22., 2009

Bird J, Behrens J, Westin J, Turesson I, Drayson M, Beetham R, et al. UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS). Br J Haematol 2009;147:22-42

Giada Bianchi et al, Impact of optimal follow-up of monoclonal gammopathy of undetermined significance on early diagnosis and prevention of myeloma-related complications Blood September 23, 2010 vol. 116 no. 12 2019-2025

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