What factors do you consider before discharging an MGUS patient from hematology clinic to safely follow with outpatient PCP?

In general, I follow the risk stratification referenced in the Mayo Clinic's recent review, and I tend to think about a clinic discharge from hematology if they have low-risk MGUS, i.e., serum M protein <1.5 gm/dL, IgG subtype, normal FLC ratio (0.26-1.65).

I then use the Lee Index to estimate the patient's risk of death, ignoring the MGUS.

If the patient's risk of death is higher than the risk of progression from MGUS to MM, a clinic discharge is in order.

Dr. @Dr. First Last's answer is quite helpful and appreciated! (especially the up-to-date reference/using iStopMM and not only going back to the IMWG 2010 cohort paper) I will offer some experience at a VA, where we have our half-day of clinic and its associated space assigned to us, with no additional expansion, with quite limited exception -- meaning we have to be prudent about who sees us in clinic vs virtual/telehealth vs e-consult (guiding PCPs with surveillance/work-up recommendations, one of our most common modalities).

We mostly see patients who are not in a low-risk setting, and often give surveillance guidance to low-int and maybe int-high-risk MGUS. High-risk MGUS, smoldering, gets seen, and often gets FDG PET/BM Bx to properly st...

This is an important question, and the answer can be quite subjective, depending on the comfort level of the patient and the physicians.

Patients with low-risk MGUS who have remained stable for the first couple of years of monitoring can potentially be monitored by their primary care physicians on a yearly basis.