Correction of the Definition of MGUS
by Dr. med. Alexander Grunenberg, and Prof. Dr. med. Christian Buske in issue 44/2017
The authors very clearly discuss the problems of monoclonal IgM gammopathy and Waldenström’s macroglobulinemia (1). At the same time they comment that only hematological and in particular serum protein electrophoresis (SPE) can show whether monoclonal gammopathy of unclear significance (MGUS) is present or not. This interpretation of MGUS is based on suggestions from the International Myeloma Working Group. From an ophthalmological perspective, however, this interpretation of MGUS cannot be confirmed. In our thesis for the American Ophthalmological Society, we showed that numerous MGUS-induced paraproteinemic keratopathies (PPK) can be observed (2). On the basis of the literature so far and numerous cases of our own, we were able to show 17 different patterns of corneal opacity in the context of MGUS-induced PPK. Only SPE—often only initiated years later—provides the correct diagnosis. Of Germany’s population of 81.6 million, 36.5 million are 50 or older. Assuming a rate of MGUS of 3%, this translates into 1.2 million people with MGUS. A postulated 1% of 1.2 million means 12 000 patients with MGUS-induced PPK in Germany, and more than 46 000 cases of MGUS-induced PPK in the United States.
Prof. Dr. med. Walter Lisch
Augenklinik der Universität Mainz
Conflict of interest statement
The author declares that no conflict of interest existss.
|1.||Grunenberg A, Buske C: Monoclonal IgM gammopathy and Waldenstrom’s macroglobulinemia. Dtsch Arztebl Int 2017; 114: 745–51 VOLLTEXT|
|2.||Lisch W, Wasielica-Poslednik J, Kivelä T, et al.: The hematologic definition of monoclonal gammopathy of undetermined significance in relation to paraproteinemic keratopathy (An American Ophthalmological Society Thesis). Trans Am Ophthalmol Soc 2016; 114: T7 PubMed Central|