Join us for an insightful discussion on myelodysplastic neoplasms (or MDS) with Drs. DeZern and Mack as we review the current standards in diagnosis of MDS using cutting edge molecular techniques. This marrow failure syndrome requires thoughtful and accurate diagnosis to ensure appropriate risk assessment for clinical decision making. We will then review relevant therapeutic choices and how to monitor on and off therapy through the case of a 68 yo male with a 6-year history of disease. We will explore key diagnostic considerations, the distinct testing required for prognostication and the therapies available in lower and high-risk disease. This episode offers practical, evidence-based insights to enhance the recognition and management of MDS.

Learning Objectives:

1. Understand accurate diagnostic testing needed in MDS including core and aspirate, iron stain, IHC, and molecular diagnostics (MK and NGS)
2. Review limited therapeutic options currently available in MDS
3. Discuss management strategies at each stage of this disease from lower risk to higher risk with suitable monitoring plans

Clinical Pearls:

1. Comprehensive diagnosis and reassessment during disease course guide best practices for treatment
2. Treatment is warranted at phases of the disease with symptoms predominantly related to cytopenia

Join Professor Brea Lipe and Professor Sagar Lonial as they discuss the changing treatment landscape of smoldering multiple myeloma (SMM). With a recently approved treatment for high-risk SMM, knowing how to differentiate and manage SMM compared with monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) has never been more crucial. Professors Lipe and Lonial review the case of a 58-year-old man in good health with no anemia or other health concerns, whose annual checkup reveals an isolated finding of elevated total protein. As they follow this patient’s journey, they discuss best practice in diagnosis, risk stratification, and management of SMM. Finally, they consider the factors affecting decision-making in the context of data from early intervention trials that aimed to either delay progression to active MM or, potentially, to cure SMM.

Learning Objectives:

• Explain the distinction between MGUS, SMM and MM
• Describe the key tests required for a basic workup of a case of suspected clonal plasma cell disorder
• Explain how patients with SMM may be risk-stratified
• Evaluate the factors that influence the decision to treat or monitor a case of high-risk SMM
• Discuss published clinical trial data on high-risk SMM management approaches

Monoclonal gammopathy of undetermined significance (MGUS) is a common but often confusing finding on serum protein electrophoresis (SPEP) reports. In this HemeTalks episode, Drs. Rahma Warsame and Jason Chen discuss how to interpret abnormal SPEP results, evaluate patients with suspected MGUS, and differentiate between benign and concerning findings. Using real-world cases, they highlight key clinical decision points, follow-up strategies, and how to communicate results with patients effectively. Tune in for expert guidance on navigating this diagnostic gray zone in hematology.

Learning Objectives:

1. Recognize the clinical significance of MGUS and how it is detected
2. Understand how to interpret MGUS lab testing results in the context of monoclonal gammopathies
3. Identify when to refer, monitor, or investigate further in patients with MGUS

Clinical Pearls:

1. MGUS is a premalignant condition that is a diagnosis of exclusion. It is defined by the presence of a serum monoclonal protein (M-protein) less than 3 g/dL, bone marrow plasma cellsl <10%, and no end organ damage (CRAB)
2. MGUS can progress to multiple myeloma, AL amyloidosis, Waldenstrom’s macroglobulinemia
3. Confirmatory tests for MGUS include: SPEP, FLC assay, and bone marrow (only if high risk features are present.