National Cancer Institute, National Institutes of Health, Center for Cancer Research, Medical Oncology Branch, 9000 Rockville Pike, Bldg 10/Room 13N240, Bethesda, MD 20892, USA.
JAMA. 2010 Dec 1;304(21):2397-404. doi: 10.1001/jama.2010.1713.
Recent data indicate that multiple myeloma is consistently preceded by the precursor states of monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma. Currently, multiple myeloma is a clinical diagnosis based on manifestations including hypercalcemia, renal failure, anemia, and bone lesions, whereas MGUS and smoldering myeloma are diagnosed based on laboratory abnormalities. Current clinical markers allow for more individualized risk stratification and counseling of these patients. However, there is a dearth of biomarkers and molecular imaging techniques capable of (1) accurately identifying patients with disease biology corresponding with high risk of progression; (2) elucidating the mechanism of transformation to multiple myeloma; and (3) forming a framework for development of targeted therapies. This case presentation and review discusses the current understanding of myeloma precursor disease and future opportunities for improving personalized management of patients with MGUS or smoldering myeloma, as well as the potential for developing early treatment strategies designed to delay and prevent development of multiple myeloma.
最近的数据表明，多发性骨髓瘤之前通常存在单克隆丙种球蛋白病（MGUS）和冒烟型骨髓瘤等前驱状态。目前，多发性骨髓瘤是一种基于临床表现的临床诊断，包括高钙血症、肾衰竭、贫血和骨病变，而 MGUS 和冒烟型骨髓瘤则基于实验室异常进行诊断。目前的临床标志物可以更好地对这些患者进行个体化的风险分层和咨询。然而，缺乏能够（1）准确识别疾病生物学与高进展风险相对应的患者的生物标志物和分子成像技术；（2）阐明向多发性骨髓瘤转化的机制；（3）为靶向治疗的发展形成框架。本病例报告和综述讨论了对骨髓瘤前驱疾病的现有认识，以及改善 MGUS 或冒烟型骨髓瘤患者个体化管理的未来机会，以及制定旨在延缓和预防多发性骨髓瘤发展的早期治疗策略的潜力。
