How do you approach work-up for a patient suspected for monoclonal gammopathy of renal significance for whom renal biopsy is contraindicated?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • Hematology

E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?

Answer from: at Academic Institution

Not very many reasons that a renal biopsy could not be done, but I would consider doing a bone marrow biopsy if the free light chain ratio was significantly abnormal, i.e. a ratio of 3 or greater. A reminder that in renal failure, both light chains may be elevated, but the ratio in benign processes ...

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Medical Oncologist at Wentworth Douglass Hospital
How does doing bone marrow biopsy help in establis...

Answer from: Medical Oncologist at Academic Institution

I agree entirely with @Ann Mohrbacher. In short, I'd biopsy whatever I could. Depending on the clinical circumstances, fat-pad aspiration would be reasonable to rule out AL amyloidosis as the specific type of MGRS. In general, I'd recommend a complete rule-out of AL amyloidosis regardless for sure s...

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