To the Editor: In their recent Grand Rounds, Dr Landgren and Mr Waxman note that of patients older than 50 years, 3.2% of white patients have monoclonal gammopathy of undetermined significance (MGUS), while the prevalence for African American and obese individuals is roughly twice diat.1 This is more than a million Americans. They recommend limited initial evaluation and follow-up every 2 to 3 years for low-risk patients with MGUS and a more thorough initial evaluation, including bone survey and bone marrow biopsy, for those with any risk factor for progression, with annual follow-up examinations.
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