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ABNORMAL SERUM PROTEIN ELELCTROPHORESIS Monoclonal gammopathy ภภภภ monoclomal protein (M protein) "##$%&'()( "#*+, -. *ภ/0,1 immunoglobulin 4#5)#. , heavy chain ' light chain 8,# Biclonal gammopathy *: 2 % = Monoclonal gammopathy -. Monoclonal gammopathy >/"#?0"#)'1 @A B$ C8'Dภ)ภ@C (benign) ' &#($ภ(Malignant) A "#=$#ภC0B%ภC,&>(.D*5: ''ภF:=@*C#G5*ภC5 B.>/"##$%&'('*+, @1"40,5H serum protein electrophoresis (SPEP), immunoelectrophoresis (IEP), urine protein electrophoresis (UPEP), ' serum free light chain assay (ภC,*&5# light chain = immunoglobulin B.1D8"##$%&'() '&>(.B. &*P#)'ภQ# ?0 ภ&ภ5=$#=A,G5*ภC5B. C0?0/ภภF ภC,ภDภ'#$%?=#)' 48,1 "#ภA1ภ@A&#($ภB.1D"8 #&-''R?=ภDภ?0 B GD0*S,1B.ภ&>5. =$#= IgG, A, D, )( E @ภ&*P#@AC8?*#$ Solitary plamacytoma of bone, multiple myeloma, amyloidosis, monoclonal gammopathy of unknown significance (MGUS) GD0*S,1B.>/ monoclonal IgM #$#@ภ&*P#@A MGUS, WaldenstromZs macroglobulinemia, amyloid, cryoglobulinemia ภB%&*P#G#G=@A&)'8#&$ >(.C,/GD0B.A,G5*ภC5= M protein "##$%&'()("#*+, &*P# #,B%)/ภ,5#5[1@AC8?* ภ=0D'B5C5 GD0*S,18,#")\8B. monoclonal gammopathy ภ&*P#@A MGUS -.% #,# 64% @1>/,8GD0*,S 1%#,# 873 A# B. Mayo Clinic "#*c 1988 ' 16% &*P#@A multiple myeloma '8,##01ภ8% &*P#@A amyloidosis, 6% &*P#@A non-HodgkinZs lymphoma, 2% &*P#chronic lymphocytic leukemia, 2% solitary or extramedullary plasmacytoma , ' ภ2% &*P# macroglobulinemia C

Solitary plamacytoma of bone ภ@ภ>/,8 monoclonal gammopathy 50% 0,8ภA.)#. =

GD0*S,1")0&)k#,8?8>/ M component B$"# #$%&'('*+, >($#Q#=ภ,5#5[1=$#1D8ภ/ภ 8 ภ'0C,D&#($&1(.= &#($ภB. plasma cells -.ภkA ,A'01A'ภ/B.>/"# multiple myeloma '%ภ1D8 "#&[>0#"0#)#.=ภDภ'"#8,#=/ immunoglobulin B.#ภ&)#(ภ(IgG, A, D, E, M) ?8 #%>5: #ภภ#$"#ภlภF@A myeloma @1B.,?* "40 MRI "#8,#= thoracic ' lumbosacral spine &>(.1(#1#ภ,5#5[1,8&*P#@A multiple myeloma 5 -.)ภ>/,8&*P#@A#$ ")0ภภF@1ภ")0 (Radiotherapy of 45 Gy) &*P#B&'(ภ)#."#ภภF 0,8 ภภ,8 50% =GD0*S,1 4, C5 C8?0ภ10 *c C8 GD0*S,1B.?8?0/ภภF'1A4,5C (disease-free survival) ?0A8 15%-45% &#(.ภGD0*S,18,#")\8ภ ภ>n#=@A ภ8#)#0#G$ D0*S,1 60 A#B.?8?0/ภภF@A Solitary plamacytoma of bone &A1/ภภFB. MD Anderson Cancer Center ),8*c 1965 ' 2000 -.GD*0 S,1B.?0/ภภF0,1ภ[14,5C1D8 ?0ภ11 *c GD0*S,18,#")\8B.?8?0/ภภFC84, 5C1D8?01,##A(GD0B. M protein '1?*B$) -. ,?0ภภ


B/B.&)k#G'?04&# o1"#1*c)'ภภF0,1 CB.?0C5CG'=A8 SPEP, IEP ' UPEP C8ภ1)#. 4"$ )0&)k#A,G5*ภC5=GD0*,S 1ภ8#?0/ภภF D

@A extramedullary plasmacytoma A( &#($ภB. plasma cell -.0##ภ= ?=ภDภ>/?0ภ"#//

B&5#)1"8,#/# -.*ภ/0,1 @>Dภ'48,8o1"#Dภ(nasal sinus) , A)1 'ภ'8&1 GD0*S,1B.,?*?8C,C,/ M component B$"##$%&'( ' "#*+, #$#ภC,>/ monoclomal protein ภ4"$ )0&)k#@A multiple myeloma ภ,5#5[1B%?0ภภC,) &#($ภB. plasma cell "# extramedullary site ภ)1?*= multiple myeloma "#?=ภDภ'?8>/1@A"#ภC,ภDภ#01ภ,8 25 % =GD0*S,1 >/,8 monoclonal protein "##$%&'('"#*+, ภภC,0,1,5H electrophoresis )( Immuno fixation 50-60% =GD0*S,1?0/ภภF0,1 @1&[>ภ/GD0*S,1B.?8&A1?0/ภภFภ8# &*P#&,'ภภ,8 10 *c E

ภ*5:A,=. ภC,&'(0,1&A,5&A)R'ภC,#/ *: 20% =GD0*S,1B&. *P#@A

multiple myeloma "#*+p/# @ภB.C,>/?0@1?8C0ภB.%A\'\\#=@A (asymptomatic multiple myeloma ) "#@AB.?8ภ@1B.,?*'0,'ภF:&[>A(*5: M protein"# &'( #01ภ,8 4.5 g/dl , ?8>/ภCภC,=&k&'("#ภDภ, @A@')5C (*5: hemoglobin ภภ,8 10.5 g/dl), *5: A'&-1ภภ,8*ภC5(Hypercalcemia), ?C,1&#(.ภmyeloma "#8,#)#.=GD0*S,1 o,=@AB.AB". #11, *+1&.1=ภ%&#5#?*=@A *ภ/0,1 *5: IgA ' M protein "# #$%&'( ภภ,8 3.0g/dl "#GD0*S,1B.?8ภ&)'8#$"40ภC5CG'@1ภ&ภCpภ&)(#ภ/"#GD0*S,1B.&*P# MGUS &#(.ภ"#ภ'p8#$ภAC,=@A?0##)'1*c (A,&.1#01B. &ภ5ภ%&#5#?*=@A) @18,# =GD0*S,1-. 2 'ภF:%A\A8 &['.1=1&,'=ภ%&#5#?*=@AA( 18 &(# (A,&.1D) ภ >/A,G5*ภC5=ภ&B8ภ#=ภDภ#)'ภภC, MRI 8G'C8ภ>1ภ:R@A @1GD0*S,1A, &.11D"8 #48,ภ=ภ%&#5#?*=@A-.ภภ")0&)k# (A8&['.1=1&,' A( 18 &(#) &>(. )'ภ&'.1@ABภ-0#B.&ภ5=$# ภ"40&A/%/"#48,ภ&*P#B&'(ภ%)/GD0*S,1B. A ,&.1D @1GD0*S,1 B.A,&1. %A\'ภF:&1, (A,&.1*#ภ') /8*&oBA,&.1?0&*P#D)(C.% ภภ C, MRI =ภDภ#)' F ภ&ภ5ภ'1C,=&-''R&k&'(ภภ,8 10%= plasma cell "#?=ภDภ, *5: M component "##$%&'( '/)(  light chain "##$%*+, 4"$ )0&)k#ภ&*P# multiple myeloma A,-/-0#ภB.pB.>/ B.,?*=@AA(ภ*,ภDภ(>/ภภภB.ภDภ)ภ) , *5:A'&-1Dภ,8*ภC5 , o,C5&4($ '?C ,1 ภภFB&A/% /0,1 melphalan-based 8,ภ/ภ=0ภ%)#"#ภ*t5/C5C#=A#?=0"#ภภF G' *ภt,8GD0*,S 14,C5 1D8?0&['.1 3 *c 18?ภkC ภภlภF= Intergroupe Francis du Myelome >/,8ภ *'Dภ81 autologous stem cell 48,1")0GD0*S,14,C5 ?0 5 *c ภ12% &*P# 52% #ภภ#$# ภภF0,1


thalidomide- , lenalidomide- ' bortezomib-based 48,1")0GD0*S,1=$#ภภp8B' 'A),,88G'C8 ภ4,5CB1. (#1,=GD0*S,1 18?ภkC=0D'#$ภk1?8Cภ/G'B5C5ภSEER G MGUS ภ M component "#GD0*S,1 #ภ&)#(ภmultiple myeloma , solitary plasmacytoma of bone , extramedullary plasmacytoma , amyloidosis, macroglobulinemia )( ภ&5\=C8#$% &)'(B.G5*ภC5 (.#v (other lymphoproliferative disorders) @A MGUS 'ภF:A( M component #01ภ,8 3.0 g/dl @1 immunoglobulin B.#ภ&)#(ภ(IgG, A, D, E, M) ?8#%>5: , A8 CBC B.*ภC5, /= marrow plasmacytosis B.C.%, ?8>/ภCภC,=&k&'()(/A'&-1Dภ,8*ภC5 ' ?8>/?C,1&#(.ภmultiple myeloma B.%A\15. ?*ภ,8#$# / M component B.AC, ' ?8A,G5*ภC5"v&>5. &C5 p/C5ภ:R"#GD0B.&*P# @A MGUS ภ&>5.=$#?*C1p @1*: 7.5% =GD0*S,1 1pภภ,8 85 *c "# %#,#GD0*,S 1@A MGUS B$) 1,348 1 A,&=0=0#= M component 1D8"#48,),8 "#48,B., ?8?0  3.0 g/dl (A8&['.11D8B. 1.2-1.3 g/dl) "#ภC,0,1,5H IEP >/ IgG 70%, IgA 12%, IgM 15% '  biclonal gammopathy "# 3% =GD0*S,1 @14#5= light chain A( kappa 61% ' lambda 39% @1&#($&1(.=?= ภDภภGD0*S,1B$ ) 160 A# >//= marrow plasmacytosis B.C.% (0%-10% , A8&['.11D8B. 3%) multiple myeloma, amyloidosis, macroglobulinemia )( ภ&5\=C8#$% &)'(B.G5*ภC5(.#v (other lymphoproliferative disorders) ภ>n#=@A "#8%=GD0*S,1 'ภ=$#&*P# 10% "# 10*c, 21% "# 20*c ' 26% "# 25*c GD0*S,18,#")\8 (65%) ภ%&#5#?*=@A multiple myeloma "#ภlภFB.A'01vภ# ภGD0&=1#1#A#&1,ภ# "#&(.ภ,5#5[1 ภ>n#=@A MGUS ?*&*P# multiple myeloma "#48, 1  32 *c ( A8&['.11D8B. 10 *c) -./8/ภ?0,8 GD0*S,1C0ภC5CG'C8&#(.?*

H &*P#B.D0ภ#,8 "#48,ภ=@A amyloidosis ภ 8# #$%)#ภ' =0&B0/, )1"C5= ภ /D0ภGB.G5*ภC5(4) #&#(.ภ&1&)(.ภ,D/ ภ&(.=//*B8,#*'1 ภภB/ &0#*B/5&,:=0( ),"'0&)',&#(.ภ&'(pC# ?Cภ&/ 14$% /,C *,=0 A,#@')5CC.% &(.&*'.1#B8B '5$#@C B0&1 8,ภ/ภD-B.G5*ภC5 ภD?=#)#0B00,1&=k=# 19 gauge B. experienced center "#GD0*S,1%#,# 70%  80% ")0G'ภC,,,8&*P#@A#$?0 'ภ13% =GD0*S,1 &B8#$# B.?8G'= ภ= amyloid B$ภภC, ?=#)#0B0 ' C,&#($ &1(.?=ภDภภ ภFB". )0G'B.p%)/GD0*S,1 amyloidosis =$#ภA(ภ")0 melphalan "#*5:D 'B%ภ*'Dภ81 autologus stem cell "#)'ภภภF0,1,5H(.#v ?0ภ8ภ")0 melphalan 8,ภ/ prednisone, ")0ภภF0,1 dexamethasone "#*5:B.D 'ภภF0,1 thalidomide ")0G'ภภFB.?0G'&48#ภ#


I GD0*S,1B./ IgM B.D=$# ( #01ภ,8 2 g/dl) ' peripheral adenopathy ภ B-cell #01ภ,8/*ภC5 "# ภ'p8=GD0*S,1 213 A# -.?0/ภ,5#5 [1ภMayo clinic ,8&*P# MGUS @1DB./= IgM "#),8*c 1960 w 1994 >/,8 14%ภ>n#=@Aภ'1&*P# non-HodgkinZs lymphoma, WaldenstromZs macroglobulinemia, amyloidosis "#=$#ภ)( Chronic lymphocytic leukemia A8&['.1=1&,'ภB.&5. ,8&*P# MGUS #ภB.?0/ภ,5#5 [1,8&*P# lymphoma A( 4 *c (1D8"#48, 0.4- 22 *c) "#GD0*S,1/148,=ภ>ภC, =@AA8#=0## ภ8#B.>n#&*P#&#($ภ(malignancies) C0ภC,C5CG'&*P#1v

J WaldenstromZs macroglobulinemia &*P#@AB.>/?01ภ( 1 "# 7 =@AB.>/?01ภ&48#&1,ภ/ myeloma) 'G'ภภB. ?8A,/Apภ&5\=@A lymphoplasmacytoid cells -.ภk/= IgM &>5.=$# \\:B.ภ,8&*P#@A#$ A( 8# 8#'0 &'(ภ"#,1,(@1 &[>1815."# 48*ภ'Dภ) 1C, )1"C5= #$%)#ภC,' ภ/D0ภGB.G5*ภC5(4) A,G5*ภC5= retina C/@C ' lymphadenopathy /= IgM ภภ,8 3 g/dL "#ภภF&/($C0#"#//. &5 "#GD0B.ภภ @1B.,?*'0, "40 Alkylating agent C,18&48# Chlorambucil -.B%")0ภBp&''?0&>5.=$# 50%- 60% = GD0*S,1 "#ภภF"#*+p/##$A(ภ ")0 nucleoside analogs ( cladribine )( fludarabine ) -.B%")0ภ Bp&''?0 70%-80% "#GD0*,S 1B.1 ?8?0/ภภF &(. ")0 ภภF@1 nucleoside analogs 8,ภ/ ภ"40 Alkylating agent (&48# cyclophosphamide) 'ภ")0 monoclonal antibody (rituximab) B%")0ภBp&''?0  90% 18&)k#?04


Diagnosis