Monoclonal Gammopathy–Associated Peripheral Neuropathy: Diagnosis and Management  Hafsa M. Chaudhry, BA, Michelle L. Mauermann, MD, S. Vincent Rajkumar, MD  Mayo Clinic Proceedings  Volume 92, Issue 5, Pages 838-850 (May 2017) DOI: 10.1016/j.mayocp.2017.02.003 Copyright © 2017 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Algorithm for evaluation of patients with a monoclonal protein identified in conjunction with peripheral neuropathy. aBased on history, physical examination, and, if appropriate, laboratory and radiologic testing. bThis group includes patients with multiple myeloma who have concurrent peripheral neuropathy. These patients require therapy to eradicate the neoplastic clone because of the nature of the malignant disorder in contrast to patients with monoclonal gammopathy of undetermined significance in whom establishing a causal relationship between neuropathy and the monoclonal protein is critical for therapeutic purposes. POEMS = polyneuropathy, osteosclerotic myeloma, endocrinopathy, monoclonal protein, and skin changes. Mayo Clinic Proceedings 2017 92, 838-850DOI: (10.1016/j.mayocp.2017.02.003) Copyright © 2017 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Algorithm for management of monoclonal gammopathy–associated peripheral neuropathy. aHigh probability of monoclonal gammopathy–associated peripheral neuropathy after excluding other causes of peripheral neuropathy, POEMS syndrome, and immunoglobulin light chain amyloid neuropathy. Neuropathy considered severe and/or progressive enough to warrant intervention. bUnlikely that M protein is causally related to neuropathy; most associations are likely coincidental. CIDP = chronic inflammatory demyelinating polyneuropathy (predominantly motor neuropathy with proximal and distal involvement); DADS = distal, acquired, demyelinating, symmetric neuropathy (mainly distal, sensory neuropathy); IVIG = intravenous immunoglobulin. Mayo Clinic Proceedings 2017 92, 838-850DOI: (10.1016/j.mayocp.2017.02.003) Copyright © 2017 Mayo Foundation for Medical Education and Research Terms and Conditions