Background Multiple myeloma (MM) is a hematological malignancy that develops over years from the asymptomatic precursors, monoclonal gammopathy of undetermined significance, and smoldering multiple myeloma. Recent evidence shows that by initiating treatment at an asymptomatic stage, outcomes in MM can be significantly improved. However, a vast majority of MM patients are diagnosed after the development of symptomatic end-organ damage and cannot reap the benefits of early treatment. The precursors of MM are easily detected by serum protein electrophoresis and free light chain assay of the serum, raising the question of whether population-based screening could detect MM at an asymptomatic stage and significantly expand the availability of early treatment in MM. Screening is a hallmark of care in many malignancies, and there are accepted criteria for when screening is appropriate. Content Here we review the available relevant evidence for the introduction of screening and discuss whether screening for MM and its precursors fulfills these criteria. We also highlight gaps in our current knowledge, most notably a lack of data on the benefits and harms of screening and the lack of a defined target population. There are ongoing studies that may fill these critical gaps in the literature, but their results are still pending. Summary Screening could lead to a paradigm shift in the care of patients with MM, but critical scientific questions need to be answered before screening of healthy individuals can be recommended. In short, we should not screen for MM and its precursors—yet.

中文翻译：

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多发性骨髓瘤及其前驱物的筛查：我们做到了吗？

背景 多发性骨髓瘤 (MM) 是一种血液恶性肿瘤，由无症状前兆、意义未明的单克隆丙种球蛋白病和冒烟型多发性骨髓瘤发展而来。最近的证据表明，通过在无症状阶段开始治疗，多发性骨髓瘤的预后可以得到显着改善。然而，绝大多数多发性骨髓瘤患者是在出现有症状的终末器官损伤后才被诊断出来的，并且无法获得早期治疗的益处。通过血清蛋白电泳和血清游离轻链测定很容易检测到 MM 的前体，这就提出了基于人群的筛查是否可以在无症状阶段检测 MM 并显着扩大 MM 早期治疗的可用性的问题。筛查是许多恶性肿瘤的护理标志，对于何时适合进行筛查有公认的标准。内容 在这里，我们回顾了引入筛查的现有相关证据，并讨论了 MM 及其前体的筛查是否满足这些标准。我们还强调了我们当前知识的差距，最明显的是缺乏有关筛查的好处和危害的数据以及缺乏明确的目标人群。正在进行的研究可能会填补文献中的这些关键空白，但其结果仍在等待中。总结 筛查可能会导致 MM 患者护理模式的转变，但在建议对健康个体进行筛查之前，需要回答关键的科学问题。简而言之，我们现在还不应该筛查 MM 及其前兆。