Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- at-risk demographic (male, age >50 years, African ancestry)
- clinically asymptomatic
- positive family history
- history of radiation exposure
- history of pesticide exposure
Outros fatores diagnósticos
- history of immunosuppression or infections
- presence of peripheral neuropathy
Fatores de risco
- male sex
- age >50 years
- African ancestry
- family history of MGUS or multiple myeloma
- immune-mediated conditions
- radiation exposure
- pesticide exposure
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- electrophoresis with immunofixation and measurement of serum immunoglobulins
- CBC with differential
- serum calcium
- serum creatinine
- urinalysis and 24-hour urine collection with electrophoresis and immunofixation
- serum free light chains assay
- metastatic bone survey (conventional x-ray or whole body low-dose CT scan)
Investigações a serem consideradas
- bone marrow aspiration and/or biopsy
- bone mineral density scan
- MRI scan
- PET scan
Algoritmo de tratamento
confirmed MGUS
Colaboradores
Autores
Shaji Kumar, MD
Professor of Medicine
Division of Hematology
Mayo Clinic
Rochester
MN
Declarações
SK has received research funding for clinical trials to the institution from Abbvie, Amgen, Allogene, Astra-Zeneca, BMS, Carsgen, GSK, Janssen, Novartis, Roche-Genentech, Takeda and Regeneron. SK has participated in consulting and advisory board activities (with no personal payments) for Abbvie, Amgen, BMS, Janssen, Roche-Genentech, Takeda, Astra-Zeneca, Bluebird Bio, Secura Biotherapeutics, Trillium, Loxo Oncology, K36, Sanofi, ArcellX, and (with personal payment) Oncopeptides, Beigene and Antengene.
Agradecimentos
Professor Shaji Kumar would like to gratefully acknowledge Dr Ola Landgren, a previous contributor to this topic.
Declarações
OL is an author of several references cited in this topic.
Revisores
Daniel Catovsky, MD
Consultant Haemato-Oncologist
Section of Haemato-Oncology
Brookes Lawley Institute of Cancer
Sutton
UK
Declarações
DC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48.Texto completo Resumo
van de Donk NW, Palumbo A,R Johnsen HE, et al. The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: recommendations from the European Myeloma Network. Haematologica. 2014 Jun;99(6):984-96.Texto completo Resumo
Bird J, Behrens J, Westin J, et al. UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS). Br J Haematol. 2009 Oct;147(1):22-42.Texto completo Resumo
Kyle RA, Durie BG, Rajkumar SV, et al; International Myeloma Working Group. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia. 2010 Jun;24(6):1121-7.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Multiple myeloma or smoldering myeloma
- Amyloidosis
- Waldenström macroglobulinemia
Mais Diagnósticos diferenciaisDiretrizes
- International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma
- The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders
Mais DiretrizesFolhetos informativos para os pacientes
Monoclonal gammopathy of undetermined significance
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