THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Monoclonal gammopathy’s 
spectrum of severity makes 
clinical decision-making difficult

S. Vincent Rajkumar, MD
S. Vincent Rajkumar, MD

While monoclonal gammopathies are common — affecting 4% to 5% of Americans 50 years old and older — the wide spectrum of severity can make decisions about management and surveillance complicated. 


To help rheumatologists make appropriate clinical decisions, an expert in monoclonal gammopathies will present the Clinical Practice session Monoclonal Gammopathy for the Rheumatologist on Tuesday from 1:00 pm – 2:00 pm in Hall B1, Building B in the Georgia World Congress Center.


S. Vincent Rajkumar, MD, Professor of Medicine at the Mayo Clinic, Rochester, Minnesota, said that the significant prevalence of monoclonal gammopathies and their association with a variety of conditions, including multiple myeloma, make this topic important for clinicians.


“Most internists and subspecialists encounter this problem because monoclonal gammopathies present in various forms,” Dr. Rajkumar said. “In addition, monoclonal gammopathies can predispose people to a variety of different conditions, including those rheumatologists see, such as arthritis or other connective tissue disorders, vasculitis, and so on.”


During his talk, Dr. Rajkumar will review how to assess patients with monoclonal gammopathies to determine who is a risk of progression to something serious. 


“The risk of progression to cancer is 1% per year,” he said. “In that course of time, patients also can develop other disorders that aren’t quite malignant but are, nonetheless, serious. This includes things like amyloidosis, rheumatoid arthritis, vasculitis, neuropathy, renal disorders, etc.”


Because monoclonal gammopathies carry the risk of progression to malignancy, some patients need to be referred correctly to a hematologist or hematologist/oncologist. Patients with an associated condition, such as a rheumatologic disorder, need to be treated appropriately in light of the monoclonal gammopathy. And patients with low risk of progression need to be followed appropriately.


To help physicians understand what is appropriate in these situations, Dr. Rajkumar will review strategies for risk stratification of patients with monoclonal gammopathies and how to distinguish between groups of patients.


“You don’t want to do a bone marrow biopsy on all patients with monoclonal gammopathies of undetermined significance,” he said. “I will discuss how clinicians can use simple biomarkers to determine who needs a bone marrow biopsy and who doesn’t. The goal is to follow patients in a risk-stratified manner. About half the patients with monoclonal gammopathies of undetermined significance only need one six-month follow-up and then reassurance. Other patients may need a follow-up annually for life.”


As part of the risk stratification discussion, he will also discuss racial disparities as monoclonal gammopathies are two times more prevalent in the African American population compared to the white population. 


“Recognizing disparities helps clinicians to better counsel patients and informs decisions regarding follow-ups,” Dr. Rajkumar said.