Hematology and Oncology Book


Monoclonal Gammopathy

Aka: Monoclonal Gammopathy, Plasma Cell Disorder
  1. See Also
    1. Monoclonal Gammopathy of Undetermined Significance (MGUS)
    2. Multiple Myeloma
    3. Hematologic Cancer
  2. Types: Plasma Cell Peripheral Disorder
    1. Common
      1. Monoclonal Gammopathy of Undetermined Significance (MGUS)
    2. Uncommon
      1. Waldenstrom Macroglobulinemia
      2. Amyloidosis
      3. B-Cell Non-Hodgkin Lymphoma
    3. Rare
      1. Plasmacytoma
      2. Plasma Cell Leukemia
  3. Screening: Indications
    1. Normocytic Anemia
    2. Non-age appropriate bone loss
    3. Proteinuria
    4. Peripheral Neuropathy
    5. Increased total protein
  4. Evaluation
    1. Establish Monoclonal Protein (M Protein) is present
      1. Obtain Serum Protein Electrophoresis (SPEP)
      2. Urine Protein electrophoresis (UPEP)
    2. Characterize the M Protein with immunofixation
      1. Clonal Bone Marrow plasma cell percentage 60% or higher in Multiple Myeloma
    3. Evaluate CRAB Criteria (end-organ injury consistent with Multiple Myeloma)
      1. Calcium
        1. Hypercalcemia (Serum Calcium >11 mg/dl)
      2. Renal Insufficiency
        1. Serum Creatinine >2 mg/dl (GFR <40 ml/min)
      3. Anemia
        1. Hemoglobin < 10
      4. Bony Lesions
        1. One or more osteolytic lesions on XRay, CT or PET CT
    4. Evaluate plasma free light chains
      1. Free Light Chain Ratio (FLC Ratio, involved to uninvolved ratio 100 of higher)
  5. References
    1. Thompson (2017) Monoclonal Gammopathy, Mayo Clinical Reviews, Rochester, MN

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