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When should bone marrow sampling be performed in patients with monoclonal gammopathy of undetermined significance (MGUS)? Currently, algorithmic approaches based on a Mayo Clinic model are used widely (Blood 2005; 106:812), but researchers in Iceland now propose an alternative model based on their iStopMM study.
About 1000 people (median age, 68) with presumed MGUS underwent bone marrow sampling; those with the IgM isotype were excluded. The researchers developed a multivariable model to predict ≥10% plasma cells — indicating a diagnosis of smoldering multiple myeloma — on bone marrow examination. The model incorporated MGUS isotype (i.e., IgG, IgA, light chain, or biclonal), monoclonal protein concentration, free light chain ratio, and tota…