Work

High‐throughput monoclonal gammopathy community monitoring programme

Year: 2026

Type: article

Abstract: To the Editor, Monoclonal gammopathy (MG) is present in 4.5% of adults older than 50 years.1 Given an annual 1% rate of progression to multiple myeloma (MM), 2 regular MG monitoring has the potential to improve MM outcomes through earlier diagnosis.3 To this end, a variety of surveillance systems have been implemented in the National Health Service (NHS), including hospital, primary care and nurse-led surveillance.4 However, as the vast majority of new MG patients are low risk and unlikely to progress, most services are inefficient and unsustainable to support population-based monitoring.5 There is a need for a robust high-throughput system that can monitor most patients in the community, while streamlining high-risk MG for review in secondary care.Here, we describe a risk-adapted MG community monitoring programme (OxCOM).Patients with new incidental MG (iMG, in contrast to screened MG) in Thames Valley were stratified and prospectively monitored.Patients with a new iMG were captured over a 24-month period (between 4 March 2021 and 3 March 2023) in an Immunology Laboratory covering a population of 2.5 million people in Oxfordshire.During its conception and design, OxCOM was discussed with key stakeholders, including general practitioners (GPs), haematology registrars and a MM/MG patient focus group.Under OxCOM, iMG cases were risk stratified into low-, intermediate-or high-risk groups.Triaging followed expert consensus criteria (Figure 1) and was achieved using a combination of automated algorithms on a task management software, together with daily review by the attending senior scientist in the central laboratory.All senior scientists received structured training to ensure consistent and safe implementation.In addition to existing infrastructure, implementation of OxCOM required only one additional laboratory staff member, primarily for administrative tasks such as issuing patient letters and completing background safety checks.Following stratification, the central laboratory recommended risk-adapted follow-up.Patients were excluded from analysis if out of area, aged 90 years or older with low-risk iMG, under regular haematology review or had malignancy diagnosed as an inpatient following iMG detection.Lowrisk iMG patients were advised to undergo regular blood

Source: British Journal of Haematology

DOI: 10.1111/bjh.70366