High‐throughput monoclonal gammopathy community monitoring programme

assessed for further investigations or face- to-face review or re-assured and moved into remote blood monitoring. Therefore, OxCOM enables a risk-stratified system for high-throughput monitoring of iMG in the community. There are some limitations in our analysis. First, as a relatively new service, there are only 2 years of follow-up data available; much remains to be understood, such as the nat-ural history of iMG between subpopulations and the incremental diagnostic yield of OxCOM follow-up particularly in low-and intermediate-risk iMG cases. High throughput of patients will enable the service to be refined iteratively, for example, through adapting risk thresholds and monitoring frequencies. Second, while OxCOM criteria stipulate a repeat screening 4 months after discovery (to capture dynamic risk in patients with a paraprotein on an upward trajectory), we have not performed this in those with IgG isotype iMG, as OxCOM has rigorously stratified low-risk iMG at detection. Third, as intent to monitor analysis was compared to a retrospective dataset in 2019, this comparison may be subject to confounding factors; nevertheless, as service demands have increased since the COVID-19 pandemic, the improved fidelity of follow-up of OxCOM in spite of this argues in favour of its efficiency. In summary, we demonstrate the feasibility of a risk-adapted high-throughput clinical monitoring service for iMG. Our approach has high fidelity, low cost and a relevant patient population in a safe and efficient way. The service, therefore, establishes an iterative model to enable tailored follow-up and monitoring of iMG, which could be adopted for sustainable surveillance of precursor states more generally.