Does my patient with a serum monoclonal spike have multiple myeloma?
Does my patient with a serum monoclonal spike have multiple myeloma?
复制标题
我的血清单克隆尖峰患者是否患有多发性骨髓瘤？
DOI：
10.1016/j.hoc.2012.02.009
复制
发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Ghobrial,IreneM
中科院分区：
文献类型：
--
作者：
Bianchi,Giada;Ghobrial,IreneM
A monoclonal spike (M spike or paraprotein) on serum protein electrophoresis (SPEP) is a frequent finding in the general population and typically is pathognomonic of an asymptomatic, premalignant condition called monoclonal gammopathy of undetermined significance (MGUS). MGUS occurs in around 3% of people older than 50 and is associated with a lifelong, low, yet non negligible, risk of progression to multiple myeloma (MM) or a related plasma cell dyscrasia. It is generally an incidental diagnosis during the evaluation of patients complaining of various symptoms such as fatigue, forgetfulness, or neuropathy. While in most outpatient encounters the paraprotein is non pathogenic and cannot explain the presenting symptoms, both patients and physicians are faced with the medical, psychological and economic consequences of a premalignant diagnosis that is non curable, and the obligation (or lack thereof) for follow up. Lifelong annual medical evaluation and blood testing are currently recommended as a mean to early diagnose progression into asymptomatic (smoldering) or active MM. Recently the foundation of these recommendations have been challenged considering the low rate of progression and potential harm related to over-testing. As MM remains an incurable disease, a timely diagnosis is crucial to establish an adequate plan of care and potentially prevent significant comorbidities such as pathologic fractures or kidney failure. In this article we will discuss the criteria for diagnosis of MGUS, smoldering MM (SMM) and symptomatic MM; the risk factors for progression from MGUS and SMM to MM; the current recommendations for follow up of MGUS patients and diagnostic evaluation of suspected MM transformation.
