Maciocia Nicola, Wechalekar Ashutosh, Yong Kwee
Department of Haematology, University College London Hospitals, London, UK.
National Amyloidosis Centre, University College London, London, UK.
Hematol Oncol. 2017 Dec;35(4):432-439. doi: 10.1002/hon.2345. Epub 2016 Nov 2.
Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma are precursor conditions of symptomatic multiple myeloma (MM). Diagnostic principles are aimed at excluding MM requiring therapy, other conditions associated with paraproteins that may require different management, and risk stratifying patients for the purposes of tailored follow-up and investigation. The International Myeloma Working Group have recently published a revised definition of MM, which singles out a small group of patients with smoldering multiple myeloma who are at very high risk of progression and organ damage; such patients are now included under the definition of MM and recommended to start anti-myeloma treatment. Furthermore, the recently published National Institute of Health and Care Excellence guideline recommends cross-sectional imaging techniques in place of skeletal survey. These recent recommendations are discussed, and practical guidance for investigation and management are presented.
意义未明的单克隆丙种球蛋白病和冒烟型多发性骨髓瘤是有症状的多发性骨髓瘤（MM）的前驱疾病。诊断原则旨在排除需要治疗的MM、与副蛋白相关的可能需要不同管理的其他疾病，并对患者进行风险分层，以便进行有针对性的随访和调查。国际骨髓瘤工作组最近发表了MM的修订定义，该定义挑选出一小部分有很高进展和器官损害风险的冒烟型多发性骨髓瘤患者；这些患者现在被纳入MM的定义，并建议开始抗骨髓瘤治疗。此外，最近发表的英国国家卫生与临床优化研究所指南推荐使用横断面成像技术代替骨骼X线检查。本文讨论了这些最新建议，并给出了调查和管理的实用指南。
