浆细胞疾病诊断与治疗的最新更新与进展

Plasma cell dyscrasias (PCDs) encompass a heterogeneous group of disorders ranging from asymptomatic precursor states such as monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) to overt multiple myeloma (MM), primary plasma cell leukemia, and systemic amyloidosis. This review is based on a structured search of PubMed, Scopus, Cochrane Library, and Web of Science for literature published between 2015 and 2025, supplemented by reference screening and major international myeloma guidelines to ensure comprehensive coverage of recent advancements. Recent years have witnessed remarkable progress in understanding disease biology, refining diagnostic tools, and expanding therapeutic strategies. Advances in genomics and cytogenetics have deepened insight into clonal evolution and prognostic markers, while next-generation flow cytometry, mass spectrometry, and high-sensitivity serum free light chain assays are revolutionizing disease detection and minimal residual disease monitoring.

Parallel improvements in imaging, including whole-body MRI and novel PET tracers, enhance accuracy in disease assessment, while artificial intelligence-driven models hold promise for predictive analytics and personalized care. Therapeutically, immunotherapies including monoclonal antibodies, bispecific antibodies, and chimeric antigen receptor T (CAR-T) cell therapies have transitioned from salvage settings to frontline use, providing deeper and more durable responses. Risk-adapted approaches, improved transplant strategies, and novel maintenance regimens are reshaping the standard of care.

Advances also extend to the management of non-myeloma PCDs, supportive care, and survivorship, underscoring the importance of patient-centered approaches. Despite these gains, challenges persist in overcoming therapy resistance, managing costs, and ensuring equitable global access to novel treatments.

Looking forward, integration of multi-omics with artificial intelligence, expansion of collaborative clinical trials, and strategies balancing cure vs. disease control will be pivotal in optimizing outcomes. This review synthesizes current evidence and highlights emerging directions shaping the evolving landscape of PCD management.