Monoclonal gammopathies and aging
The monoclonal gammopathies are a group of disorders that are most prevalent in the elderly. Their common denominator is overproduction of a homogeneous immunoglobulin by plasma cells derived from a single ancestral B lymphocyte. The overproduction represents at least partial escape from normal controls. Monoclonality notwithstanding, the disorders have a remarkable range: They vary from a rather benign form, in which the abnormal protein is present without marked clinical manifestations, to the highly malignant form characterized by multiple myeloma. The wide variety of signs, symptoms and complications that may be produced by these disorders can present a physician with serious diagnostic and therapeutic dilemmas, especially in older patients with a background of other chronic illnesses. Still, the diagnosis and the planning of therapy can often be based on careful assessment of fairly routine historical information, physical findings, and laboratory studies. A crucial aspect of management lies in deciding when a patient's circumstances warrant a decision only to follow the patient expectantly and when a change in circumstances, such as a rise in the serum level of the abnormal protein, mandates initiation of treatment.
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