Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Hematology, Fiona Stanley Hospital, Perth, WA, Australia.
Blood Cancer J. 2020 May 6;10(5):52. doi: 10.1038/s41408-020-0319-0.
We conducted a retrospective review of multiple myeloma (MM), smoldering multiple myeloma (SMM), and monoclonal gammopathy of undetermined significance (MGUS) patients seen at Mayo Clinic to determine whether a bone marrow biopsy (BM) is necessary in all patients diagnosed with a monoclonal protein. A total of 2254 MM, 397 SMM, and 5836 MGUS patients were included in the study. A total of 29 (1.3%) MM patients "without CRAB/FLC" were identified where BM or advanced imaging was critical for diagnosis, 8 (0.3% MM cohort) of whom were diagnosed with MM solely on BM findings (plasma cells > 60%). Without BM or advanced imaging none of these patients would be classified low-risk MGUS. A total of 314 (79%) MGUS-like SMM patients were identified where classification of SMM was based on BM findings. Without BM 97 would be classified as low/low-intermediate-risk MGUS and 151 intermediate or high-risk MGUS; 66 had missing information precluding classification. Only three (<1% SMM cohort) were low-risk MGUS without abnormalities in hemoglobin, calcium, and renal function. In patients presenting with low-risk MGUS and normal hemoglobin, calcium, and renal function, the risk of missing a diagnosis of SMM and MM by omitting BM is <1%. BM should be deferred in these patients in preference to clinical and laboratory monitoring.
我们对在梅奥诊所就诊的多发性骨髓瘤（MM）、冒烟型多发性骨髓瘤（SMM）和意义未明单克隆丙种球蛋白血症（MGUS）患者进行了回顾性研究，以确定在诊断出单克隆蛋白的所有患者中是否都需要进行骨髓活检（BM）。共有 2254 例 MM、397 例 SMM 和 5836 例 MGUS 患者纳入研究。共发现 29 例（1.3%）“无 CRAB/FLC”的 MM 患者，其 BM 或高级影像学对诊断至关重要，其中 8 例（0.3%的 MM 患者）仅根据 BM 发现（浆细胞>60%）诊断为 MM。如果没有 BM 或高级影像学检查，这些患者中没有任何患者会被归类为低风险 MGUS。共发现 314 例（79%）MGUS 样 SMM 患者，其 SMM 的分类基于 BM 发现。如果没有 BM，97 例将被归类为低/低中危 MGUS，151 例为中危或高危 MGUS；66 例有缺失信息，无法进行分类。只有 3 例（<1%的 SMM 患者）无血红蛋白、钙和肾功能异常，为低危 MGUS。对于有低危 MGUS 且血红蛋白、钙和肾功能正常的患者，通过省略 BM 漏诊 SMM 和 MM 的风险<1%。在这些患者中，应推迟进行 BM，而倾向于进行临床和实验室监测。
