Monoclonal gammopathy of undetermined significance diagnostic study of choice: Difference between revisions
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=== Study of choice === | === Study of choice === | ||
There is no single gold standard test for the diagnosis of Monoclonal gammopathy of undetermined significance. bone marrow aspiration and biopsy is indicated in all patients with an M-protein ≥1.5 g/dL | There is no single gold standard test for the diagnosis of Monoclonal gammopathy of undetermined significance. bone marrow aspiration and biopsy is indicated in all patients with an M-protein ≥1.5 g/dL. | ||
=== Diagnostic Criteria === | === Diagnostic Criteria === | ||
Non-IgM MGUS — Non-IgM MGUS (IgG, IgA, or IgD MGUS) is diagnosed by meeting the following three criteria | Non-IgM MGUS — Non-IgM MGUS (IgG, IgA, or IgD MGUS) is diagnosed by meeting the following three criteria | ||
* Presence of a serum monoclonal protein (M-protein, whether IgA, IgG, or IgD), at a concentration <3 g/dL. | * Presence of a serum monoclonal protein (M-protein, whether IgA, IgG, or IgD), at a concentration <3 g/dL. | ||
* Fewer than 10 percent clonal plasma cells in the bone marrow. | * Fewer than 10 percent clonal plasma cells in the bone marrow. | ||
* The absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the plasma cell proliferative process. | * The absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the plasma cell proliferative process. | ||
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* Presence of a serum monoclonal protein (M-protein, whether IgA, IgG, or IgD), at a concentration <3 g/dL.<ref name="pmid7955402">{{cite journal |vauthors=Kyle RA |title=The monoclonal gammopathies |journal=Clin. Chem. |volume=40 |issue=11 Pt 2 |pages=2154–61 |date=November 1994 |pmid=7955402 |doi= |url=}}</ref> | * Presence of a serum monoclonal protein (M-protein, whether IgA, IgG, or IgD), at a concentration <3 g/dL.<ref name="pmid7955402">{{cite journal |vauthors=Kyle RA |title=The monoclonal gammopathies |journal=Clin. Chem. |volume=40 |issue=11 Pt 2 |pages=2154–61 |date=November 1994 |pmid=7955402 |doi= |url=}}</ref> | ||
* Fewer than 10 percent clonal lymphoplasmacytic/plasma cells in the bone marrow. | * Fewer than 10 percent clonal lymphoplasmacytic/plasma cells in the bone marrow. | ||
* The absence of end-organ damage such as anemia, constitutional symptoms, hyperviscosity, lymphadenopathy, or hepatosplenomegaly related to the plasma cell proliferative process | * The absence of end-organ damage such as anemia, constitutional symptoms, hyperviscosity, lymphadenopathy, or hepatosplenomegaly related to the plasma cell proliferative process | ||
Light chain MGUS — Light chain MGUS (LC-MGUS) is diagnosed by meeting the following three criteria<ref name="pmid25439696">{{cite journal |vauthors=Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF |title=International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma |journal=Lancet Oncol. |volume=15 |issue=12 |pages=e538–48 |date=November 2014 |pmid=25439696 |doi=10.1016/S1470-2045(14)70442 | Light chain MGUS — Light chain MGUS (LC-MGUS) is diagnosed by meeting the following three criteria<ref name="pmid25439696">{{cite journal |vauthors=Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF |title=International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma |journal=Lancet Oncol. |volume=15 |issue=12 |pages=e538–48 |date=November 2014 |pmid=25439696 |doi=10.1016/S1470-2045(14)70442-5 |url=}}</ref> | ||
* The presence of an abnormal FLC ratio (ie, ratio of kappa to lambda FLCs <0.26 or >1.65) | * The presence of an abnormal FLC ratio (ie, ratio of kappa to lambda FLCs <0.26 or >1.65) | ||
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== References == | == References == | ||
<references /> | |||
Revision as of 15:58, 13 August 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]
Overview
Diagnostic Study of Choice
Study of choice
There is no single gold standard test for the diagnosis of Monoclonal gammopathy of undetermined significance. bone marrow aspiration and biopsy is indicated in all patients with an M-protein ≥1.5 g/dL.
Diagnostic Criteria
Non-IgM MGUS — Non-IgM MGUS (IgG, IgA, or IgD MGUS) is diagnosed by meeting the following three criteria
- Presence of a serum monoclonal protein (M-protein, whether IgA, IgG, or IgD), at a concentration <3 g/dL.
- Fewer than 10 percent clonal plasma cells in the bone marrow.
- The absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the plasma cell proliferative process.
IgM MGUS — IgM MGUS is diagnosed by meeting the following three criteria[1][2][3]
- Presence of a serum monoclonal protein (M-protein, whether IgA, IgG, or IgD), at a concentration <3 g/dL.[4]
- Fewer than 10 percent clonal lymphoplasmacytic/plasma cells in the bone marrow.
- The absence of end-organ damage such as anemia, constitutional symptoms, hyperviscosity, lymphadenopathy, or hepatosplenomegaly related to the plasma cell proliferative process
Light chain MGUS — Light chain MGUS (LC-MGUS) is diagnosed by meeting the following three criteria[2]
- The presence of an abnormal FLC ratio (ie, ratio of kappa to lambda FLCs <0.26 or >1.65)
- Increased level of the appropriate involved light chain (eg, increased kappa FLC in patients with a ratio >1.65 and increased lambda FLC in patients with a ratio <0.26)
- No monoclonal immunoglobulin heavy chain (IgG, IgA, IgD, or IgM)
- Fewer than 10 percent clonal lymphoplasmacytic cells in the bone marrow
- The absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the plasma cell proliferative process.
References
- ↑ "Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group". Br. J. Haematol. 121 (5): 749–57. June 2003. PMID 12780789.
- ↑ 2.0 2.1 Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF (November 2014). "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma". Lancet Oncol. 15 (12): e538–48. doi:10.1016/S1470-2045(14)70442-5. PMID 25439696.
- ↑ Kyle RA (May 1978). "Monoclonal gammopathy of undetermined significance. Natural history in 241 cases". Am. J. Med. 64 (5): 814–26. PMID 645746.
- ↑ Kyle RA (November 1994). "The monoclonal gammopathies". Clin. Chem. 40 (11 Pt 2): 2154–61. PMID 7955402.