Pasqualetti P, Festuccia V, Collacciani A, Casale R
Department of Internal Medicine and Public Health, School of Medicine and Surgery, University of L'Aquila, Italy.
Acta Haematol. 1997;97(3):174-9. doi: 10.1159/000203676.
Patients with monoclonal gammopathy of undetermined significance (MGUS) have a serum monoclonal component (M-component), but no evidence of multiple myeloma, macroglobulinaemia, amyloidosis or other plasma cell proliferative disease. A long-term follow-up study (median 11.5 years) has been carried out in 263 cases of MGUS, 159 males (60.5%) and 104 females (39.5%), aged 40-89 years (median 66.5 years). The actuarial probability for malignant transformation was 6.1, 15.4 and 31.3% at 5, 10 and 20 years, respectively. At the final evaluation, 157 patients (59.7%), 119 (45.3%) of whom with no increase and 38 (14.4%) with an increase in serum M-component, died of causes unrelated to MGUS and without development of any plasma cell proliferative disease; 47 patients (17.9%) were still alive without increase in M-component; 11 patients (4.1%) were still alive and at follow-up presented values of serum M-component > 30 g/l without any evidence of plasma cell proliferative or lymphoproliferative disease; 48 patients (18.3%) developed multiple myeloma (35 cases, 13.1%), solitary plasmacytoma of the bone (2 cases, 0.8%), macroglobulinaemia (4 cases, 1.6%), malignant lymphoma (3 cases, 1.2%), amyloidosis (2 cases, 0.8%), chronic lymphocytic leukaemia (1 case, 0.4%), and plasma cell leukaemia (1 case, 0.4%). The patients developing multiple myeloma, solitary plasmacytoma, macroglobulinaemia and plasma cell leukaemia had an increase in serum M-component, whereas no increase was found in malignant lymphoma, amyloidosis and chronic lymphocytic leukaemia. These findings and the data in the literature suggest that MGUS could be considered a preneoplastic condition; since no clinical and laboratory features are able to identify in advance the patients at high risk of disease progression, each patient must be followed up indefinitely.
意义未明的单克隆丙种球蛋白病（MGUS）患者血清中有单克隆成分（M成分），但无多发性骨髓瘤、巨球蛋白血症、淀粉样变性或其他浆细胞增殖性疾病的证据。对263例MGUS患者进行了一项长期随访研究（中位随访时间11.5年），其中男性159例（60.5%），女性104例（39.5%），年龄40 - 89岁（中位年龄66.5岁）。5年、10年和20年时恶性转化的精算概率分别为6.1%、15.4%和31.3%。在最终评估时，157例患者（59.7%）死亡，其中119例（45.3%）血清M成分无增加，38例（14.4%）血清M成分增加，均死于与MGUS无关的原因，且未发生任何浆细胞增殖性疾病；47例患者（17.9%）仍存活，M成分无增加；有11例患者（4.1%）仍存活，随访时血清M成分值>30 g/l，无任何浆细胞增殖性或淋巴细胞增殖性疾病的证据；48例患者（18.3%）发生了多发性骨髓瘤（35例，13.1%）、骨孤立性浆细胞瘤（2例，0.8%）、巨球蛋白血症（4例，1.6%）、恶性淋巴瘤（3例，1.2%）、淀粉样变性（2例，0.8%）、慢性淋巴细胞白血病（1例，0.4%）和浆细胞白血病（1例，0.4%）。发生多发性骨髓瘤、孤立性浆细胞瘤、巨球蛋白血症和浆细胞白血病的患者血清M成分增加，而恶性淋巴瘤、淀粉样变性和慢性淋巴细胞白血病患者血清M成分无增加。这些发现以及文献中的数据表明，MGUS可被视为一种肿瘤前状态；由于没有临床和实验室特征能够提前识别疾病进展高危患者，因此必须对每位患者进行无限期随访。
