Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma
ABSTRACT Patients with monoclonal gammopathy of undetermined significance (MGUS) have a monoclonal protein but no evidence of multiple myeloma, macroglobulinemia, amyloidosis, or related disorders. In a long-term follow-up (median, 19 years) of 241 patients with MGUS, 53 (22%) developed multiple myeloma (36 patients), macroglobulinemia (7 patients), primary systemic amyloidosis (7 patients), or malignant lymphoproliferative disease (3 patients). Fifty-seven patients (24%) remained stable and were alive, while 124 patients (51%) died of causes unrelated to the monoclonal gammopathy. Multiple myeloma was diagnosed in the 36 patients 23 to 251 months (median, 9.6 years) after recognition of the M-protein. Smoldering multiple myeloma (SMM) is characterized by a serum M-protein level > 30 g/1 and > 10% plasma cells in the bone marrow but no anemia, renal insufficiency, or lytic lesions. Differentiation of MGUS and SMM from multiple myeloma and macroglobulinemia is difficult at the time of diagnosis of the M-protein, and the patients must be followed up indefinitely.
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ABSTRACT: A 62-year-old female visited our clinic with progressively decreased vision in both eyes beginning 12 years prior. Idiopathic corneal opacity in all layers of the cornea was found in both eyes. One year later, we performed penetrating keratoplasty on the undiagnosed right eye. During post-surgical follow-up, corneal edema and stromal opacity recurred, and penetrating keratoplasty was performed two more times. The patient's total serum protein level, which had previously been normal, was elevated prior to the final surgery. She was diagnosed with monoclonal gammopathy of undetermined significance. We made a final diagnosis of monoclonal gammopathy-associated crystalline keratopathy after corneal biopsy. Monoclonal gammopathy-associated crystalline keratopathy is difficult to diagnose and may lead to severe visual loss. A systemic work-up, including serologic tests like serum protein or cholesterol levels, is needed in patients with unexplainable corneal opacity.Korean Journal of Ophthalmology 06/2011; 25(3):202-5.