Why Don’t We Treat MGUS? What MGUS Means for Multiple Myeloma Risk

If MGUS can become multiple myeloma, why don't doctors treat it? IMF Medical Advisor Dr. Joseph Mikhael explains why MGUS is typically not treated and why routine monitoring is important.

Learn what MGUS means, why most people with MGUS do not go on to develop multiple myeloma, and why doctors consider the potential risks of treatment when deciding whether treatment is needed. Dr. Mikhael also explains why regular follow-up is important for identifying changes before MGUS becomes active myeloma.

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View the Transcript

Dr. Joe Mikhael:

If MGUS will turn into myeloma, why don't we treat MGUS?

Hi everybody. Dr. Joe here from the International Myeloma Foundation, and I'm going to explain why we typically do not treat MGUS in a minute or less.

MGUS is a pre-myeloma condition, monoclonal gammopathy of undetermined significance that actually happens in 5% of people over the age of 40. So it's very, very common. And it just means that there is a small abnormal protein in the blood, but it has not yet grown to a point that it causes damage. We typically don't treat it because most of those patients will not go on to develop multiple myeloma. We want to treat people when the risk is more imminent so that we don't expose people to any risks of treatment that they may not need.

However, it is very important to follow these patients because we know if left unfollowed, the disease can grow and become quite severe. So if someone has MGUS, we want to make sure that they're followed routinely to make sure that we capture it before it becomes active myeloma.

Have more questions about multiple myeloma? Drop them in the box below using the hashtag #AskTheIMF.

Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO

International Myeloma Foundation Medical Advisor
TGen, City of Hope Cancer Center—Phoenix, AZ, USA

Dr Mikhael is a Professor in the Clinical Genomics and Therapeutics Division at the Translational Genomics Research Institute (TGen), an affiliate of City of Hope Cancer Center. He is also the Director of Myeloma research at the HonorHealth Research Institute in Scottsdale, Arizona. Dr Mikhael specializes clinically in plasma cell disorders, namely multiple myeloma, amyloidosis, and Waldenstrom’s macroglobulinemia. He is the PI of many clinical trials, primarily in relapsed multiple myeloma, and his other clinical research interests include pharmaco-economics, communication skills, and media relations.

Dr. Mikhael recently served as the Chief Medical Officer of the International Myeloma Foundation (IMF) from 2018 to 2026 – he now serves as Medical Advisor to the IMF to provide guidance and strategic input in areas such as patient education, health disparities, collaboration with partners, international research, and publications.

Dr Mikhael has published over 200 peer-reviewed articles in these fields and lectures internationally on a regular basis. Dr. Mikhael is deeply committed to health disparities in myeloma and is the chair of the Diversity, Equity and Inclusion Council at TGen. Dr. Mikhael is heavily involved in training future researchers and mentors junior faculty worldwide. Dr. Mikhael is an active member of the International Myeloma Working Group (IMWG) and recently led the ASCO guidelines in myeloma. Dr. Mikhael also serves as the Treasurer on the executive of the American Society of Hematology.

Dr. Mikhael did his medical training in Canada, including a fellowship in Multiple Myeloma at the Princess Margaret Hospital in Toronto. He also obtained his master’s degree in education from the University of Toronto. He then worked at the Mayo Clinic Arizona as a Hematologist from 2008-2018.

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