This paper proposes a new clinical framework — monoclonal gammopathy of thrombotic significance (MGTS) — defining criteria for thrombotic disorders in which a monoclonal (M)-protein from a clonal plasma or B-cell disorder directly and mechanistically causes thrombosis, distinct from MGUS-associated thrombotic risk driven by clonal burden.
Only monoclonal protein-induced immune thrombocytopenia and thrombosis currently meets the authors' strict criteria for MGTS; thrombotic microangiopathy and antiphospholipid syndrome are provisionally classified as 'thrombotic syndromes associated with M-proteins' pending causal evidence, and multifactorial thrombotic associations (e.g., general VTE risk in MM) are explicitly excluded from MGTS.
This is a narrative/expert review proposing a classification framework — no original patient data or outcomes are reported. Causal validation for most M-protein-associated thrombotic disorders is still lacking. Diagnostic criteria and management strategies are not yet consensus-based.
When a patient with a known M-protein develops thrombosis, clinicians should assess whether the M-protein is the direct mechanistic driver (qualifying as MGTS) versus an incidental or multifactorial association — this distinction matters for clonal-directed therapy decisions. Currently, immune thrombocytopenia and thrombosis linked to an M-protein is the clearest indication to treat the underlying clonal disorder as part of thrombosis management.
Explore related topics
