Die monoklonale Gammopathie (un)klarer Signifikanz

 

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Definition und Inzidenz Monoklonale Gammopathien sind häufig, haben jedoch nicht immer eine klinische Bedeutung.

Diagnose Sie wird über Serumelektrophorese, Immunfixation und Bestimmung der freien Leichtketten gestellt. Für die Aufarbeitung eines auszuschließenden multiplen Myeloms gibt es konkrete, risikoadaptierte Empfehlungen. Die weitere Diagnostik besteht dann aus einer Knochenmarkpunktion, einer Untersuchung des 24h-Sammelurins und einer Ganzkörper-Bildgebung. Zum Ausschluss auch kleiner Osteolysen sollte anstatt der historischen Röntgenaufnahmen nach „Pariser Schema“ eine CT ohne Kontrastmittel durchgeführt werden. Mit der MRT gelingt der Nachweis fokaler Läsionen im Knochenmark.

Verlaufskontrollen und Prognose Eine MGUS-Verlaufskontrolle sollte nach individuellem Risiko geplant werden. Dennoch weisen Personen mit MGUS eine erhöhte Morbidität auf. Man findet hier häufiger Osteoporosen und ein erhöhtes Infektionsrisiko.

MGUS-assoziierte Erkrankungen In den meisten Fällen genügen für die weitere Abklärung eine gründliche Anamnese und körperliche Untersuchung.

Abstract

Monoclonal gammopathies are a frequently diagnosed entity. However, the diagnosis is not always clinically relevant. The diagnosis of a monoclonal gammopathy requires serum electrophoresis, immunofixation and free light chain measurement. Sometimes, monoclonal gammopathies occur in the course of transient or autoimmune inflammation. Further diagnostics should only be performed after risk assessment according to Mayo criteria. In non-low risk patients, a symptomatic myeloma has to be ruled out via SLiM-CRAB criteria. The diagnostic work-up should include whole-body MRI and a bone marrow puncture as well as a 24 h urine sample. If it does not imply myeloma, the diagnosis of MGUS is confirmed and a follow-up after 6 months is recommended. After that, low-risk patients only need SLiM-CRAB screening at clinical signs of progression. All other patients should receive serologic follow-ups once a year. Importantly, MGUS patients show higher morbidity. Amongst a higher prevalence of osteoporosis and immunodeficiency, a wide array of MGUS-associated diseases such as AL amyloidosis, deposition diseases and Fc binding-dependent effects can occur. This article gives an overview over the work-up, observation and caveats of monoclonal gammopathy of (un)known significance.

Publication History

Article published online:
30 May 2022

© 2022. Thieme. All rights reserved.

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