[Monoclonal gammopathy--multiple myeloma].

The diagnosis of monoclonal gammopathy of undetermined significance (MGUS), requires both the detection of monoclonal gammopathy by immunofixation on the one hand, and the exclusion of signs of multiple myeloma (MM) on the other. The risk of an MGUS evolving into an MM is about 1% per year. The possibility of an MM should be considered in particular in elderly patients with an elevated ESR, anemia, recurrent infections and hypercalcemia. The diagnosis of MM is established on the basis of a constellation of major and minor criteria that includes characteristic results of serum and urine electrophoresis and immunofixation, routine lab and bone marrow (plasma cell infiltration) studies as well as complications (anemia, renal failure, hypercalcemia, osteolysis). Standard chemotherapy comprises melphalan-prednisone or chemotherapy VAD. Improved results have been achieved with high-dose chemotherapy plus various forms of stem cell transplantation. To treat recurrences, thalidomide and bortezomib are now available.