Publication Date:
2015-12-03
Description:
Monoclonal gammopathy of undetermined significance (MGUS) has a 1% overall risk of progression to symptomatic disease per year. Previously, monoclonal Ig (M-protein) isotype (IgA or IgM) and concentration (≥10g/L) have been used to risk stratify patients. In 2005, Rajkumar et al. reported on three independent risk factors: M-protein concentration ≥15g/L, M-protein isotype IgA or IgM, and an abnormal free light chain ratio (FLCr). An abnormal FLCr, determined by polyclonal antibody-based nephelometric analysis, had a 7.4 fold relative risk for MGUS progression in the absence of the other two factors. The International Myeloma Working Group (IMWG) recommends inclusion of all three factors for MGUS risk stratification, with low risk patients being referred to primary care while, intermediate and higher risk patients have bone marrow biopsies and skeletal surveys at presentation and are then followed annually by a haematologist. Here, we compare costs and resource use associated with the IMWG recommendations with the previous risk stratification approach. The model consists of a decision tree structure from incidental finding of an M-protein level 7000 per year. Applying the IMWG recommendations, including FLCr analysis, therefore leads to substantial cost savings and reduced resource use in both the diagnostic and long-term pathways. Benefits to patients include fewer required bone marrow biopsies and skeletal surveys, while fewer patients identified as low risk are predicted to progress to symptomatic disease. As practice moves towards a more systematic out-of-hospital approach, further benefits are anticipated for the management of patients with MGUS. Haematology clinic resources can then be allocated to other conditions, while maintaining confidence that all MGUS patients are appropriately managed. Disclosures Pratt: The Binding Site Group Ltd: Other: Member of Medical Advisory Board. Harding:The Binding Site Group Ltd: Employment, Membership on an entity's Board of Directors or advisory committees. Powner:The Binding Site Group Ltd: Employment. Hughes:The Binding Site Group Ltd: Employment. Cook:The Binding Site Group Ltd: Other: Member of Medical Advisory Board.
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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