In the past years we have learned much about the genetics and biology of multiple myeloma (MM) and plasma cell disorders. It is now clear that (nearly) all MM cases are preceded by a benign phase of expansion of monoclonal PCs known as monoclonal gammopathy of undetermined signi fi cance (MGUS). It is also known that MGUS is a common condition that increases in prevalence with advancing age. Trying to couple the understanding we have of the genetics of the disease with the speci fi c risk of progression from MGUS to MM could be of importance in determining different risk of progression with associated management strategies. Currently there is limited information regarding the speci fi c factors that drive the progression from MGUS to MM and the risk associated with different genetics classes of the disease. A better understanding of the biologic steps that are needed for progression from a benign stage to a malignant form of the disease is needed, as well as better markers to provide a more dynamic monitoring for incipient disease evolution. In this chapter we discuss some of the background knowledge and basic biology of the disease, and some future strategies for a better surveillance of patients with MGUS.
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