Monoclonal gammopathy of increasing significance: time to screen?
Monoclonal gammopathy of increasing significance: time to screen?
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DOI：
10.3324/haematol.2022.281802
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发表时间：
2023-06-01
期刊：
影响因子：
10.1
通讯作者：
Ramasamy, Karthik
中科院分区：
文献类型：
--
作者：
Chen, Lucia Y.;Drayson, Mark;Bunce, Christopher;Ramasamy, Karthik
单克隆伽玛病是一种常见的克隆性b细胞或浆细胞疾病。重要的是，每个多发性骨髓瘤（MM）病例之前都有MG。尽管现在的临床算法允许在mm诱导的组织损伤（CRAB）发生之前对具有恶性肿瘤生物标志物的患者进行早期治疗，但大多数患者的诊断仍然很晚。重新审视在临床实践中如何管理MG以及是否需要筛查是很重要的。由于MG和其他医学合并症的患病率都随着年龄的增长而上升，MG对除恶性进展以外的疾病状态的贡献程度往往不清楚。这可能导致监测失误和对器官功能障碍的认识不足，这可能发生在具有临床意义的单克隆γ病（MGCS）中。因此，发展到MM和/或MGCS的模型需要进一步完善。虽然MG目前是偶然发现的，但在这一领域正在进行的研究中提出了进行筛查的理由。筛查具有早期发现和预防MGCS和延迟MM表现的潜在益处，但重要的缺点包括对个人的社会心理影响和医疗保健服务的资源负担。MG术语应该随着我们对已经开始修订MG命名法的条件和基因组特征的日益了解而转变。人们对MG的生物学了解甚少，通常是从MM的生物学中推断出来的，这是没有帮助的。我们回顾了有关MG筛查的文献和病例。我们特别强调了需要重点关注的领域，以建立MG筛查。
Monoclonal gammopathy (MG) is a frequently detected clonal B-cell or plasma-cell disorder. Importantly, every multiple myeloma (MM) case is preceded by MG. Although clinical algorithms now allow earlier treatment of patients with biomarkers of malignancy before MM-induced tissue damage (CRAB) occurs, most patients are still diagnosed late. It is important to revisit how MG should be managed in clinical practice and whether screening is required. As the prevalence of MG and other medical co-morbidities both rise with increasing age, the degree of contribution of MG to disease states other than malignant progression is often unclear. This can lead to monitoring lapses and under recognition of the organ dysfunction that can occur with monoclonal gammopathy of clinical significance (MGCS). Therefore, models of progression to MM and/or MGCS require further refinement. While MG is currently detected incidentally, a case for screening has been made with ongoing studies in this area. Screening has the potential benefit of earlier detection and prevention of both MGCS and delayed MM presentations, but important drawbacks include the psychosocial impact on individuals and resource burden on healthcare services. MG terminology should transition alongside our increasing understanding of the condition and genomic characterization that have already begun to revise the MG nomenclature. The biology of MG has been poorly understood and is often inferred from the biology of MM, which is unhelpful. We review the literature and case for MG screening in this paper. In particular, we highlight areas that require focus to establish screening for MG.
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