Monoclonal gammopathy of undetermined significance (MGUS) is, in many ways, a unique hematologic entity. Unlike most hematologic conditions in which the diagnosis is intentional and credited to hematologists, the discovery of MGUS is most often incidental and made by nonhematologists. MGUS is considered an obligate precursor to several lymphoplasmacytic malignancies, including immunoglobulin light-chain amyloidosis, multiple myeloma, and Waldenström macroglobulinemia. Therefore, long-term follow-up is generally recommended. Despite its high prevalence, there is surprisingly limited evidence to inform best clinical practice both at the time of diagnosis and during follow-up. We present 7 vignettes to illustrate common clinical management questions that arise during the course of MGUS. Where evidence is present, we provide a concise summary of the literature and clear recommendations on management. Where evidence is lacking, we describe how we practice and provide a rationale for our approach. We also discuss the potential harms associated with MGUS diagnosis, a topic that is rarely, if ever, broached between patients and providers, or even considered in academic debate.

中文翻译：

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我如何处理意义未定的单克隆丙种球蛋白病

意义不明的单克隆丙种球蛋白病（MGUS）在很多方面都是一种独特的血液学疾病。与大多数血液病的诊断是有意的并归功于血液学家的不同，MGUS 的发现通常是偶然的，并且是由非血液学家做出的。MGUS 被认为是多种淋巴浆细胞恶性肿瘤的必然前兆，包括免疫球蛋白轻链淀粉样变性、多发性骨髓瘤和华氏巨球蛋白血症。因此，一般建议长期随访。尽管其患病率很高，但在诊断时和随访期间提供最佳临床实践信息的证据却非常有限。我们提出 7 个小插曲来说明 MGUS 过程中出现的常见临床管理问题。如果有证据，我们会提供简洁的文献总结和明确的管理建议。在缺乏证据的情况下，我们会描述我们的实践方式并为我们的方法提供理由。我们还讨论了与 MGUS 诊断相关的潜在危害，这是一个很少（如果有的话）在患者和提供者之间提出的话题，甚至在学术辩论中也很少考虑。