Current trends in the diagnosis, therapy and monitoring of the monoclonal gammopathies.

This paper provides an overview of developments in the diagnosis, therapy and monitoring of the monoclonal gammopathies, particularly multiple myeloma and AL amyloidosis. Consensus statements outlining diagnostic criteria for monoclonal gammopathy of undetermined significance (MGUS), myeloma and amyloidosis have been recently published. Understanding of the biology and pathogenesis of myeloma has accelerated in the last decade and provides the basis for improved prognostication and therapeutic interventions. Myeloma therapy has progressed with the introduction of autologous and allogeneic stem cell transplantation and the recent introduction of the novel agents, thalidomide, lenalidomide and bortezomib. Each of these therapeutic advances has contributed to the improved survival seen in this patient population. Similar treatment advances are occurring in AL amyloidosis. While serum and urine electrophoretic analysis remain the "gold standard" laboratory techniques for the accurate and cost-effective monitoring of the monoclonal gammopathies, new tests such as the free light chain assays have a complementary role. New guidelines for the monitoring of both myeloma and AL amyloidosis have been produced that incorporate these newer tests.