Monoclonal Gammopathy of Undetermined Significance (MGUS)

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• 1. ????????
• ???/??????
• ??????
• ???
• ???
• ?????
• Monoclonal Gammopathy of
  Undetermined Significance (MGUS)

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Monoclonal Gammopathies
M.Waldenström (2)
Solitary Plasmacytoma (1)
Others (3)
Smoldering Myeloma (4)
MGUS (63)
Lymphoprolif. Diseases (3)
Amyloidosis AL (10)
Multiple Myeloma (14)
n 882
Adapted from Mayo Clinic cases, 1998
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2. ????????

• ?(???????,?????)
• ????(???????????)
• ???(70??M??)????
• ??????????
• SLE

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??

• ??B???????????
• ???????????????????(???)???????????.

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??????Multiple myeloma, MM
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???

• ??
• ?????? B ??
• ?????
• ???? ?????
• ????????
• ???? ??

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????

• 1. ??
• ?????/????????????????????????B??B??
  ??????????????????? ????,????????????(r.gene
  Ig)??????????????????????????????????,????????????
  ??????????(M??)?????????

Mature
Blasts
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M protein

• - ???/????????B?????????????????????????????
  
• 99??????
• ???????????????
• IgG gt 50, IgA 20-25, IgD 1-3,light chain 20
• IgE, IgM uncommon
• - 1 ?????

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0.5
1
6.5
7
9
52
2
22
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2. ???????

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• ???????????

• ????????
• ??

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?????

• ???????????????
• ?????????????
• ???????????????B????
• ??????????????????
• ?????c-myc?IgH???

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3. ??????

• ??????1,?????10
• ??? 78/10?(??),1.42.3/10?(??)
• 2004 ?????15,270?
• ?????????,?62? ?61?
• ???????33??
• ????,110????

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??????

• ????
• ????????
• ???????
• ??
• ??
• ??????
• ??????
• ??????(IgA??IgG?,ESR??,?????,???????????????)
• ????
• ?????
• ????(IgG?30IgA????)

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• ??? ??
• ?? ???
• X?????
• M???? ??
• ????? ???
• ??????????????
• ??????
• 
  
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  ???

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???????????????????????????????,????,????,????????
????????
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Lytic lesions(Punched out lesions) on X Ray.
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Plasma cell myeloma - collapse of vertebral body
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????????
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????/?????
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???? ???? ?
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• ????????
• ????????
• ???,????
• ??????,?
• 1???????
• ??

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Rouleaux formation occurs when red blood cells
form stacks or rolls.
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??????
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• RBC?Hb?????,??????
• WBC?BPC????,????,??????
• ???????
• (lt20,???lt2109/L)

??
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• ?????
• ??????
• ?????1590
• ????
• - ????,?????,????
• - ??????,?????
• - ??????????

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Myeloma Bone Marrow
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(No Transcript)
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(No Transcript)
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• ????????
• ????????

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Cells containing multiple immunoglobulin globules
are known as Mott cells .
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1.?????????????????????2.???3.?????
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??
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1.Normal Plasma2.Polyclonal Hyperglobulinemia
3.Monoclonal Spike4.Bence Jones proteins in
urine
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Figure Serum Protein Electrophoresis. Identific
ation of Monoclonal Immunoglobulins
                                              
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MM??????????SP??????????????????M????G?A?M??????
??????????????( ? ?)??????,?????MM
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MM??????????SP?????????????????M????G?A?M???????
?????????( ? ?)??????,?????MM
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MM??????????SP???????????????????M????G?A?M????
??????????A?( IgA)???( ? ?)?????,????M???,???????
??????????IgA?????,?IgA?MM
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(No Transcript)
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??

• 
  

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• ????????????,???()
• 30??B-J??()
• ?????????????,???

??
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?????????

• ????????gt15
• ????????
• ???????
• ?? M ?? (IgG gt30 g/l IgA gt20 g/l)
• ? M?? (Bence Jones proteinuria)
• ?????????

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?? ??????( Smoldering Myeloma )

• ??MM????,???(gt35y)???
• ???????????,??????

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2. ????

• ??????
• ??M???????
• ????????????B??????r.gene.Ig????M??(),
  ??
• ?????????????
• ??????CLL?
• ??????
• ????

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Prognostic Factors

• ?????
• ??
• ß-2????
• C-???? (high levels poor outcome)
• Il-6 and sIl-6 receptors (high levels poor
  outcome)
• CD38 cells (high levels poor outcome)
• Il-2 levels (high levels good outcome)

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• Prognostic Indicators
• ????
• ????
• Bence-Jones ???
• One study indicated that a shortened survival
  time was associated with these.

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?????

• ??????,???????
• ??MM?
• ????MM?