Monoclonal Gammopathy of Neurological Significance: Toward an Integrated Hematologic–Neurologic Perspective—A Single-Center Retrospective Study

Monoclonal gammopathies of clinical significance (MGCSs) are entities in which a small hematological clone produces a monoclonal immunoglobulin capable of causing organ damage. Neurological involvement remains difficult to diagnose and treat, especially in the context of incidental monoclonal gammopathy of undetermined significance (MGUS)–peripheral neuropathy (PN) associations. We conducted a single-center retrospective study at Fundeni Clinical Institute, Bucharest, from January 2015 to December 2025. The reference population included 300 patients with MGUS. The diagnosis of MGNS was established clinically and/or electrophysiologically, with the exclusion of alternative causes of neuropathy. In total, 35 patients with MGNS were identified (prevalence 11.7%). Neuropathy was more common in IgM MGUS (36.7%) compared to IgG (15%), IgA (14.3%), or light chain MGUS (16.7%), with an increased risk for IgM (OR 3.27, p < 0.001). A total of 88.5% of patients received hematological treatment; neurological response was noted in the majority of treated patients. Mortality was 14.3%, and median OS was not reached. Our findings confirm the dissociation between low clonal load and the severity of organ involvement. IgM MGUS is associated with a significantly increased risk of neuropathy, supporting the need for systematic screening for MGUS in patients with PN and for a multidisciplinary approach.