An illness most often seen in elderly men, the clinical features may be more like those oflymphoma, i.e. peripherallymph node enlargement and symptoms due to bone marrow infiltration, or symptoms of hyperviscosity may predominate.
• General malaise and weight loss
• Lymph node enlargement
• Symptoms of hyperviscosity (headaches, visual disturbance)
• Symptoms of anaemia
• A bleeding tendency
Hb normal or low
WBC normal or low
Platelets normal or low
ESR usually raised
BLOOD FILM usually shows rouleaux formation
BONEMARROWASPIRATEusually shows infiltration with Iymphoplasmacytoid cells
PROTEIN ELECTROPHORESIS shows an IgM paraprotem
Alkylating agents and, in younger patients, more intensive doxorubicin-containing regimens produce meaningful responses but recurrence is inevitable. In patients in whom hyperviscosity is the main problem, regular plasmapheresis can be helpful. Death results from progressive bone marrow infiltration and infection.
Monoclonal gammopathy of undetermined significance (MGUS)
This is characteristically seen in older people; a paraprotein is found in the blood but the level is low «2g litre “). Patients may be quite asymptomatic and the paraprotein detected as a result of investigations for some quite different reason. The blood count is usually normal and there is no renal impairment or bone destruction. In such patients, no specific treatment is required but they should be followed up regularly in case they later develop lymphoma or myeloma.