PDF(Pubmed)
Abstract：
The study of monoclonal serum proteins has led to the generation of two major theories: one proposing that individuals who had monoclonal proteins without any symptoms or evidence of end-organ damage have a benign condition, the other one suggesting that some individuals with asymptomatic monoclonal proteins may progress to multiple myeloma and thus are affected by a monoclonal gammopathy of undetermined significance (MGUS). Longitudinal studies of subjects with MGUS have supported the second theory. Subsequent studies have characterized and defined the existence of another precursor of multiple myeloma, smoldering multiple myeloma (SMM), intermediate between MGUS and multiple myeloma. Primary molecular events, chromosome translocations, and chromosome number alterations resulting in hyperploidy, required for multiple myeloma development, are already observed in myeloma precursors. MGUS and SMM are heterogeneous conditions with the presence of tumors with distinct pathogenic phenotypes and clinical outcomes. The identification of MGUS and SMM patients with a molecularly defined high risk of progression to MM offers the unique opportunity of early intervention with a therapeutic approach on a low tumor burden.
摘要：
对单克隆血清蛋白的研究导致了两种主要理论的产生：一种提出具有单克隆蛋白而没有任何症状或终末器官损伤证据的个体患有良性疾病，另一项提示,一些无症状单克隆蛋白患者可能进展为多发性骨髓瘤,因此受到意义不明的单克隆丙种球蛋白病(MGUS)的影响.对MGUS受试者的纵向研究支持了第二种理论。随后的研究已经确定了多发性骨髓瘤的另一种前体的存在，闷烧的多发性骨髓瘤（SMM），介于MGUS和多发性骨髓瘤之间。主要分子事件,染色体易位,和染色体数量改变导致超倍体，多发性骨髓瘤发展所必需的，已经在骨髓瘤前体中观察到。MGUS和SMM是存在具有不同致病表型和临床结果的肿瘤的异质病症。具有分子上确定的进展为MM的高风险的MGUS和SMM患者的鉴定提供了在低肿瘤负荷上用治疗方法进行早期干预的独特机会。
