Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Eur J Haematol. 2013 Oct;91(4):356-60. doi: 10.1111/ejh.12172. Epub 2013 Aug 17.
Diagnostic criteria for monoclonal gammopathy of undetermined significance (MGUS) require quantification of bone marrow plasma cells (BMPCs) and skeletal survey to discriminate between MGUS and multiple myeloma (MM). By contrast, recent published guidelines suggest that these procedures could be avoided in the presence of serum monoclonal spike (M-spike) of small amount (≤1.5 g/dL). Aim of this study is to better quantify the risk of missing a diagnosis of MM, not performing bone marrow aspirate and skeletal survey in patients with M-spike ≤ 1.5 g/dL asymptomatic for bone pain.
We reviewed data of 2282 patients consecutively observed from January 1974 to December 2010 in our single hematology department. We considered eligible for this study 1271 patients with grade <2 NCI bone pain, confirmed to have an MGUS or an MM after extensive standardized diagnostic workup including bone marrow biopsy, skeletal bone survey and laboratory tests.
The risk of finding a BMPC infiltration ≥10% in patients with an M-spike ≤ 1.5 g/dL was very low (7.3%), although significantly different according to IgH isotype (4.7% for IgG vs. 20.5% for IgA). The risk of finding bone lesions with M-spike ≤ 1.5 g/dL was negligible (2.5%), regardless of IgH isotype.
In asymptomatic patients with M-spike of small amount (≤1.5 g/dL): (i) BMPC evaluation may be reasonably avoided in patients with IgG M-spike, while should always be part of diagnostic workup in the presence of IgA M-spike and (ii) skeletal survey, less predictive for MM, should not be routinely indicated irrespective of IgH isotype.
单克隆丙种球蛋白病的不确定意义（MGUS）的诊断标准需要定量骨髓浆细胞（BMPC）和骨骼检查，以区分 MGUS 和多发性骨髓瘤（MM）。相比之下，最近发表的指南建议，在存在少量（≤1.5 g/dL）血清单克隆峰（M-峰）的情况下，可以避免这些程序。本研究的目的是更好地量化在无症状骨痛且 M-峰≤1.5 g/dL 的患者中不进行骨髓抽吸和骨骼检查而漏诊 MM 的风险。
我们回顾了 1974 年 1 月至 2010 年 12 月在我们单血液学部门连续观察的 2282 名患者的数据。我们认为有资格进行这项研究的是 1271 名患有 2 级以下 NCI 骨痛的患者，在广泛的标准化诊断工作后，这些患者被确认为 MGUS 或 MM，包括骨髓活检、骨骼骨骼检查和实验室检查。
在 M-峰≤1.5 g/dL 的患者中，发现 BMPC 浸润≥10%的风险非常低（7.3%），尽管根据 IgH 同种型（IgG 为 4.7%，IgA 为 20.5%）存在显著差异。在 M-峰≤1.5 g/dL 的患者中，发现骨病变的风险可以忽略不计（2.5%），无论 IgH 同种型如何。
在 M-峰量较小（≤1.5 g/dL）的无症状患者中：（i）在 IgG M-峰的患者中，BMPC 评估可能是合理的，可以避免，而在 IgA M-峰存在时，应始终作为诊断工作的一部分；（ii）骨骼检查对 MM 的预测性较差，无论 IgH 同种型如何，都不应常规进行。
