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Management of paraproteinaemia

Department of Haematology, Imperial College, London, UK

Correspondence to:
Correspondence to:
Dr Donald Macdonald
Room 1L05, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; d.h.macdonald{at}imperial.ac.uk

A paraprotein is a monoclonal immunoglobulin or light chain present in the blood or urine; it is produced by a clonal population of mature B cells, most commonly plasma cells. In individuals aged >50 years the incidence of a paraprotein is 3.2%. Plasma cell disorders can be considered as a spectrum of conditions ranging from monoclonal gammopathy of undetermined significance (MGUS), through asymptomatic, to symptomatic myeloma. MGUS is defined by a low level of paraprotein <30 g/l, bone marrow plasma cells <10% and the absence of myeloma related organ or tissue damage (predominantly renal, skeletal or bone marrow impairment.) MGUS requires no therapy and the overall risk of progression to myeloma is 1% per year. Myeloma remains incurable with a median survival of 3–4 years; autologous stem cell transplant can prolong survival, if appropriate. Thalidomide in combination with dexamethasone has an emerging role in the treatment of myeloma.

Abbreviations: CC, conventional chemotherapy; CLL, chronic lymphocytic leukaemia; C-VAMP, cyclophosphamide, vincristine, adriamycin and prednisolone; HDT, high dose therapy; IPI, international prognostic index; LPL/WM, lymphoplasmacytic lymphoma/Waldenstrom macroglobulinaemia; MGUS, monoclonal gammopathy of undetermined significance; MP, melphalan and prednisolone; NHL, non-Hodgkin’s lymphoma; PBSC, peripheral blood stem cell collection; ROTI, related organ or tissue impairment; VAD, vincristine and doxorubicin