What are the recommended follow-up intervals for monitoring patients diagnosed with MGUS in primary care?

Recommended follow-up intervals for monitoring patients diagnosed with monoclonal gammopathy of undetermined significance (MGUS) in primary care:

While the provided NICE guideline context does not explicitly specify follow-up intervals for MGUS, it does provide monitoring intervals for related plasma cell disorders such as smouldering myeloma, which is a condition on the spectrum between MGUS and active myeloma. Patients with smouldering myeloma should be monitored every 3 months for the first 5 years, then the frequency of monitoring should be adjusted based on disease stability. This suggests that for MGUS, which has a lower risk of progression, less frequent monitoring may be appropriate initially, with adjustments based on clinical judgment and stability of the paraprotein.

In primary care, patients with MGUS are typically monitored with periodic clinical assessment and laboratory tests including serum protein electrophoresis and serum-free light-chain assay to detect any progression. The exact interval is often individualized but commonly ranges from 6 to 12 months initially, with longer intervals if stable over time.

Therefore, the recommended approach is to monitor MGUS patients regularly, often annually or biannually, with more frequent monitoring if risk factors for progression or changes in clinical status occur. Referral to haematology is advised if there are signs of progression or new symptoms.

Summary: Monitor MGUS patients in primary care approximately every 6 to 12 months initially, adjusting frequency based on stability and risk factors, with more frequent monitoring (e.g., every 3 months) reserved for smouldering myeloma or if progression is suspected ¹.