Study results demonstrated that conducting new patient visits via telehealth with advanced practice providers allows for quicker identification, assessment, and surveillance of patients with monoclonal gammopathy of undetermined significance (MGUS), a pre-malignant plasma cell disorder, at increased risk of developing certain hematological cancers. 

These data were first presented by Kelly O’Brien, NP, MSN, RN, University of Colorado Medicine, Aurora, Colorado, at JADPRO Live 2024. 

In this study, researchers crafted guidelines based on disease subtype and testing characteristics of patients with MGUS and enrolled 23 patients at risk of progression to multiple myeloma, amyloidosis, Waldenstrom macroglobulinemia, chronic lymphocytic leukemia, chronic lymphocytic lymphoma, and smoldering multiple myeloma. Referrals were reviewed by a nurse navigator and patients underwent standard work up and testing, with certain patients additionally undergoing additional bone marrow biopsy with or without PET/CT scans if indicated. A new patient visit was scheduled and completed with an APP via Telehealth or, if indicated for patients with smoldering or multiple myeloma, a doctor via telehealth. Follow-ups were requested, and the patient underwent further testing for the next appointment.

At the time of the new patient visit, patients were categorized by risk as ultra-low (n = 2), low (n = 2), low-intermediate (n = 7), intermediate (n = 6), high-intermediate (n = 4), smoldering multiple myeloma (n = 1), and lymphoma (n = 1) and further categorized by subtype as lymphoma (n = 1), IgM lambda (n = 1), IgM kappa (n = 1), IgA lambda (n = 1), Kappa FLC (n = 2), IgC lambda (n = 2), IgA kappa (n = 3), or IgG kappa (n = 12). After 12 months, the distribution of diagnoses reported 4% of patients with lymphoma, 9% of patients with smoldering multiple myeloma, and 87% of patients with MGUS. 

Conducting new patient visits via telehealth allows for complete results to be obtained before the appointment, reducing the number of trips to the clinic for the patient. Additionally, O’Brien et al noted, “Brisk identification of newly diagnosed MGUS patients and risk stratification from diagnostic workup allows a surveillance plan to be formulated and prompt determination of progression and initiation of treatment when indicated.” 

Source: 

O’Brien K, Sidor K, Watson K, et al. Managing monoclonal gammopathy of undetermined significance in a virtual setting. Presented at JADPRO Live 2024. November 14-17, 2024. Abstract JL1233C