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🌱 來自: plasma cell dyscrasias

monoclonal gammopathy of uncertain significance (MGUS)

• Premalignancy w/ clonal plasma cell (PC) proliferation.
• No e/o other B-cell disease.
• <10% monoclonal PCs in BM,
• <3 g/dL serum M-protein,
• & no MM-related organ dysfunction s/s

monoclonal gammopathy of uncertain significance (MGUS)

(NEJM 2018;378:241)

• ✓ CBC, Ca, Cr, SPEP, serum free light chains, UPEP w/ immunofixation (to exclude MM)
• Close observation: repeat SPEP in 6 mo, then → yearly thereafter if stable
• ~1%/y or ~25% lifetime risk → MM, WM, amyloidosis, or malign. lymphoproliferative dis.
• Abnormal serum free light chain ratio & M protein ≥1.5 g/dL: ↑ risk of progression to MM

Smoldering Multiple Myeloma

• Need whole-body MRI or PET-CT to rule out occult bone lesions
• Risk of prog. 10%/y, depends on [M protein], subtype, FLC ratio. No defined role for Rx yet though trials ongoing (NEJM 2013;369:438; Blood 2019;134:781; JCO 2020;38:1126).