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Forsteo ® (teriparatide)
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Forsteo® (teriparatide): Use in Patients with Monoclonal Gammopathy of Undetermined Significance
Patients with MGUS are at risk for progression to multiple myeloma or related malignancies. Patients with skeletal malignancies or bone metastases should be excluded from treatment with Forsteo (contraindication).
Monoclonal gammopathy of undetermined significance (MGUS) has an approximately 1% per year risk for progression to multiple myeloma or related malignancies.1
If a patient has MGUS with a likelihood of progression to multiple myeloma, the clinician may consider not prescribing teriparatide.
Risk factors for a patient with MGUS to progress to multiple myeloma or related malignancies include
size of the M protein when diagnosed1
abnormal serum free light chain ration3
presence of IgM or IgA M protein1
more than 5% bone marrow plasma cells1
presence of Bence Jones proteinuria1
polyclonal immunoglobulin reduction1, and
elevated sedimentation rate.1
1. Kyle RA, Rajkumar SV. Monoclonal gammopathy of undetermined significance and smouldering multiple myeloma: emphasis on risk factors for progression. Br J Haematol. 2007;139(5):730-743. http://dx.doi.org/10.1111/j.1365-2141.2007.06873.x
2. Kyle RA, Therneau TM, Rajkumar SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006;354(13):1362-1369. http://dx.doi.org/10.1056/NEJMoa054494
3. Rajkumar SV, Kyle RA, Therneau TM, et al. Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance. Blood. 2005;106(3):812-817. http://dx.doi.org/10.1182/blood-2005-03-1038
BMD = bone mineral density
IgA = immunoglobulin A
IgM = immunoglobulin M
M = monoclonal
MGUS = monoclonal gammopathy of undetermined significance
Date of Last Review: 03 March 2020