Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM): novel biological insights and development of early treatment strategies
Open Access
- 26 May 2011
- journal article
- review article
- Published by American Society of Hematology in Blood
- Vol. 117 (21), 5573-5581
- https://doi.org/10.1182/blood-2011-01-270140
Abstract
Monoclonal gammopathy of unknown significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic plasma cell dyscrasias, with a propensity to progress to symptomatic MM. In recent years there have been improvements in risk stratification models (involving molecular markers) of both disorders, which have led to better understanding of the biology and probability of progression of MGUS and SMM. In the context of numerous molecular events and heterogeneous risk of progression, developing individualized risk profiles for patients with MGUS and SMM represents an ongoing challenge that has to be addressed by prospective clinical monitoring and extensive correlative science. In this review we discuss the current standard of care of patients with MGUS and SMM, the use of risk models, including flow cytometry and free-light chain analyses, for predicting risk of progression. Emerging evidence from molecular studies on MGUS and SMM, involving cytogenetics, gene-expression profiling, and microRNA as well as molecular imaging is described. Finally, future directions for improving individualized management of MGUS and SMM patients, as well as the potential for developing early treatment strategies designed to delay and prevent development of MM are discussed.Keywords
This publication has 59 references indexed in Scilit:
- Prevalence and risk of progression of light-chain monoclonal gammopathy of undetermined significance: a retrospective population-based cohort studyThe Lancet, 2010
- International Myeloma Working Group molecular classification of multiple myeloma: spotlight reviewLeukemia, 2009
- Increased risk of monoclonal gammopathy in first-degree relatives of patients with multiple myeloma or monoclonal gammopathy of undetermined significanceBlood, 2009
- Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic diseaseBlood, 2008
- MicroRNAs regulate critical genes associated with multiple myeloma pathogenesisProceedings of the National Academy of Sciences of the United States of America, 2008
- AID-Dependent Activation of a MYC Transgene Induces Multiple Myeloma in a Conditional Mouse Model of Post-Germinal Center MalignanciesCancer Cell, 2008
- Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myelomaBlood, 2008
- Genetic events in the pathogenesis of multiple myelomaBest Practice & Research Clinical Haematology, 2007
- Frequent Engagement of the Classical and Alternative NF-κB Pathways by Diverse Genetic Abnormalities in Multiple MyelomaCancer Cell, 2007
- Clinical Course and Prognosis of Smoldering (Asymptomatic) Multiple MyelomaThe New England Journal of Medicine, 2007