Elis Avishay, Radnay Judith, Shapiro Hava, Itzhaky Dganit, Manor Yosef, Lishner Michael
Department of Medicine, Meir Medical Center, Kfar Saba, Israel.
Isr Med Assoc J. 2006 Dec;8(12):840-2.
Monoclonal gammopathy of undetermined significance is defined by the presence of: low serum and/or urine monoclonal protein level; less than 10% plasma cells in bone marrow; normal serum calcium, creatinine and hemoglobinlevels; and no bone lesions on full skeletal X-ray survey.
To study the necessity of bone marrow examination for the diagnosis and clinical course of MGUS.
We retrospectively screened the medical records of all patients in whom monoclonal protein was found in the serum during 2001-2002 in the medical laboratories of Meir Medical Center. Asymptomatic patients who had serum monoclonal immunoglobulin G < 3.0 g/dl or IgA < 2.0 g/dl or IgM < 1.0 g/dl without anemia, renal failure, hypercalcemia or any bone lesions on skeletal survey were eligible. Full records of patients who were evaluated in the hematology clinic were available (group 1). The remaining patients were followed by their family physicians; thus we had access only to their electronic files including laboratory results and new diagnoses (group 2). Demographic and clinical parameters as well as clinical course werewere evaluated.
Both groups (57 and 255 patients, respectively) had similar demographic, laboratory and clinical characteristics. Bone marrow examination was performed in 30 of 57 patients (group 1): 16 were normal, 8 had an excess of normal plasma cells, and 6 had excess of pathologic plasma cells. However, only in two of the latter six could a diagnosis of multiple myeloma be established. All group 1 patients were followed for 22 +/- 11 months and onlytwo developed overt multiple myeloma. During the same period, 6 of 255 patients (group 2) were diagnosed as multiple myeloma and 3 as MGUS in other hospitals. The rest had a stable course with no change in their laboratory values.
Our findings suggest that bone marrow examination should not be performed routinely in patients who fulfill strict clinical and laboratory criteria of MGUS.
意义未明的单克隆丙种球蛋白病的定义如下：血清和/或尿中单克隆蛋白水平低；骨髓中浆细胞少于10%；血清钙、肌酐和血红蛋白水平正常；全身骨骼X线检查无骨病变。
研究骨髓检查对意义未明的单克隆丙种球蛋白病诊断及临床病程的必要性。
我们回顾性筛查了2001年至2002年期间在梅尔医疗中心医学实验室发现血清中单克隆蛋白的所有患者的病历。无症状患者，血清单克隆免疫球蛋白G<3.0g/dl或IgA<2.0g/dl或IgM<1.0g/dl，无贫血、肾衰竭、高钙血症或骨骼检查发现任何骨病变，符合入选标准。血液科门诊评估的患者有完整记录（第1组）。其余患者由其家庭医生随访；因此我们仅能获取他们的电子文件，包括实验室检查结果和新诊断（第2组）。对人口统计学和临床参数以及临床病程进行评估。
两组（分别为57例和255例患者）在人口统计学、实验室检查和临床特征方面相似。57例患者中的30例（第1组）进行了骨髓检查：16例正常，8例正常浆细胞增多，6例病理浆细胞增多。然而，后6例中只有2例可确诊为多发性骨髓瘤。第1组所有患者随访22±11个月，只有2例发展为明显的多发性骨髓瘤。同期，255例患者中的6例（第2组）在其他医院被诊断为多发性骨髓瘤，3例被诊断为意义未明的单克隆丙种球蛋白病。其余患者病程稳定，实验室检查值无变化。
我们的研究结果表明，对于符合意义未明的单克隆丙种球蛋白病严格临床和实验室标准的患者，不应常规进行骨髓检查。
