{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:59:37Z","timestamp":1787500777175,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,8,17]],"date-time":"2013-08-17T00:00:00Z","timestamp":1376697600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2013,10]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n \n Diagnostic criteria for monoclonal gammopathy of undetermined significance (\n MGUS<\/jats:styled-content>\n ) require quantification of bone marrow plasma cells (\n BMPC<\/jats:styled-content>\n s) and skeletal survey to discriminate between\n MGUS<\/jats:styled-content>\n and multiple myeloma (\n MM<\/jats:styled-content>\n ). By contrast, recent published guidelines suggest that these procedures could be avoided in the presence of serum monoclonal spike (\n M<\/jats:styled-content>\n \u2010spike) of small amount (\u22641.5\u00a0g\/dL). Aim of this study is to better quantify the risk of missing a diagnosis of\n MM<\/jats:styled-content>\n , not performing bone marrow aspirate and skeletal survey in patients with\n M<\/jats:styled-content>\n \u2010spike\u00a0\u2264\u00a01.5\u00a0g\/dL asymptomatic for bone pain.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We reviewed data of 2282 patients consecutively observed from\n J<\/jats:styled-content>\n anuary 1974 to\n D<\/jats:styled-content>\n ecember 2010 in our single hematology department. We considered eligible for this study 1271 patients with grade <2\n NCI<\/jats:styled-content>\n bone pain, confirmed to have an\n MGUS<\/jats:styled-content>\n or an\n MM<\/jats:styled-content>\n after extensive standardized diagnostic workup including bone marrow biopsy, skeletal bone survey and laboratory tests.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The risk of finding a\n BMPC<\/jats:styled-content>\n infiltration \u226510% in patients with an\n M<\/jats:styled-content>\n \u2010spike\u00a0\u2264\u00a01.5\u00a0g\/dL was very low (7.3%), although significantly different according to\n IgH<\/jats:styled-content>\n isotype (4.7% for\n IgG<\/jats:styled-content>\n vs. 20.5% for\n IgA<\/jats:styled-content>\n ). The risk of finding bone lesions with\n M<\/jats:styled-content>\n \u2010spike\u00a0\u2264\u00a01.5\u00a0g\/dL was negligible (2.5%), regardless of\n IgH<\/jats:styled-content>\n isotype.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n In asymptomatic patients with\n M<\/jats:styled-content>\n \u2010spike of small amount (\u22641.5\u00a0g\/dL): (i)\n BMPC<\/jats:styled-content>\n evaluation may be reasonably avoided in patients with\n IgG M<\/jats:styled-content>\n \u2010spike, while should always be part of diagnostic workup in the presence of\n IgA M<\/jats:styled-content>\n \u2010spike and (ii) skeletal survey, less predictive for\n MM<\/jats:styled-content>\n , should not be routinely indicated irrespective of\n IgH<\/jats:styled-content>\n isotype.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ejh.12172","type":"journal-article","created":{"date-parts":[[2013,7,17]],"date-time":"2013-07-17T04:04:50Z","timestamp":1374033890000},"page":"356-360","source":"Crossref","is-referenced-by-count":23,"title":["Monoclonal gammopathy of undetermined significance: a new proposal of workup"],"prefix":"10.1111","volume":"91","author":[{"given":"Silvia","family":"Mangiacavalli","sequence":"first","affiliation":[{"name":"Division of Hematology Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Cocito","sequence":"additional","affiliation":[{"name":"Division of Hematology Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Pochintesta","sequence":"additional","affiliation":[{"name":"Division of Hematology Fondazione IRCCS Policlinico San Matteo University of 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