Summary
Definition
History and exam
Key diagnostic factors
- em situação de risco demográfico (homem, idade > 50 anos, de ascendência africana)
- clinicamente assintomática
- história familiar positiva
- história de exposição à radiação.
- história de exposição a pesticidas
Other diagnostic factors
- história de imunossupressão ou infecções
- presença de neuropatia periférica
Risk factors
- sexo masculino
- idade >50 anos
- Ancestralidade africana
- história familiar de MGUS ou mieloma múltiplo
- doenças mediadas imunologicamente
- exposição à radiação
- exposição a pesticidas
Diagnostic investigations
1st investigations to order
- eletroforese com imunofixação e medição de imunoglobulinas séricas
- Hemograma completo com diferencial
- cálcio sérico
- creatinina sérica
- urinálise e coleta de urina de 24 horas com eletroforese e imunofixação
- ensaio de cadeias leves livres no soro
- pesquisa de metástase óssea (raios X convencionais ou TC do corpo inteiro de baixa dose)
Investigations to consider
- biópsia e/ou aspiração da medula óssea
- densitometria óssea
- ressonância nuclear magnética (RNM)
- tomografia por emissão de pósitrons (PET)
Treatment algorithm
gamopatia monoclonal de significado indeterminado (MGUS) confirmada
Contributors
Authors
Shaji Kumar, MD
Professor of Medicine
Division of Hematology
Mayo Clinic
Rochester
MN
Disclosures
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.
Acknowledgements
Professor Shaji Kumar would like to gratefully acknowledge Dr Ola Landgren, a previous contributor to this topic.
Disclosures
OL is an author of several references cited in this topic.
Peer reviewers
Daniel Catovsky, MD
Consultant Haemato-Oncologist
Section of Haemato-Oncology
Brookes Lawley Institute of Cancer
Sutton
UK
Disclosures
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.
References
Key articles
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.Full text Abstract
van de Donk NW, Palumbo A, 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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Diferenciales
- Mieloma múltiplo ou indolente
- Amiloidose
- Macroglobulinemia de Waldenström
More DiferencialesGuías de práctica clínica
- The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders
- International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma
More Guías de práctica clínicaFolletos para el paciente
Monoclonal gammopathy of undetermined significance
Más Folletos para el pacienteInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad