Multiple myeloma diagnostic criteria: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Multiple myeloma}} | {{Multiple myeloma}} | ||
{{CMG}} {{AE}} {{HMHJ}} | {{CMG}} {{AE}} {{HMHJ}}; {{SSK}}; {{shyam}} | ||
==Overview== | ==Overview== | ||
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===Revised Criteria for the Diagnosis of Multiple Myeloma=== | ===Revised Criteria for the Diagnosis of Multiple Myeloma=== | ||
The [[diagnosis]] of [[multiple myeloma]] requires the following:<ref name="lancet">Rajkumar, S. Vincent, Meletios A. Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar et al. "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma." The Lancet Oncology 15, no. 12 (2014): e538-e548</ref> | The [[diagnosis]] of [[multiple myeloma]] requires the following:<ref name="lancet">Rajkumar, S. Vincent, Meletios A. Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar et al. "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma." The Lancet Oncology 15, no. 12 (2014): e538-e548</ref><ref name="pmid18971951">{{cite journal |vauthors=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |date=January 2009 |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=}}</ref><ref name="pmid12780789">{{cite journal |vauthors= |title=Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group |journal=Br. J. Haematol. |volume=121 |issue=5 |pages=749–57 |date=June 2003 |pmid=12780789 |doi= |url=}}</ref><ref name="pmid16212152">{{cite journal |vauthors=Rajkumar SV, Kyle RA |title=Multiple myeloma: diagnosis and treatment |journal=Mayo Clin. Proc. |volume=80 |issue=10 |pages=1371–82 |date=October 2005 |pmid=16212152 |doi=10.4065/80.10.1371 |url=}}</ref> | ||
*≥10% clonal [[plasma cells]] in [[bone marrow]] | *≥10% clonal [[plasma cells]] in [[bone marrow]] | ||
'''OR''' | '''OR''' | ||
*[[biopsy]]-proven bony or [[Plasmacytoma|extramedullary plasmacytoma]], | *[[biopsy]]-proven bony or [[Plasmacytoma|extramedullary plasmacytoma]], | ||
'''With''' one or more of the | '''With''' one or more of the [[Multiple myeloma|myeloma]]-defining events: | ||
*CRAB features: | *CRAB features: | ||
**'''[[Hypercalcemia]]''': [[Calcium|serum calcium]] >0·25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2·75 mmol/L (>11 mg/dL) | **'''[[Hypercalcemia]]''': [[Calcium|serum calcium]] >0·25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2·75 mmol/L (>11 mg/dL) | ||
| Line 19: | Line 19: | ||
**'''[[Anemia]]''': [[hemoglobin]] value of >2 g/dL below the lower limit of normal, or a [[hemoglobin]] value <10 g/dL | **'''[[Anemia]]''': [[hemoglobin]] value of >2 g/dL below the lower limit of normal, or a [[hemoglobin]] value <10 g/dL | ||
**'''[[Bone]] [[lesion]]''': one or more osteolytic [[lesions]] on [[Skeleton|skeletal]] [[radiography]], [[CT-scans|CT]], or [[PET scan|PET-CT]] | **'''[[Bone]] [[lesion]]''': one or more osteolytic [[lesions]] on [[Skeleton|skeletal]] [[radiography]], [[CT-scans|CT]], or [[PET scan|PET-CT]] | ||
* | *Biomarkers of malignancy: | ||
**'''[[Bone marrow]] [[plasma cell]] burden''': Clonal [[bone marrow]] [[plasma cell]] percentage ≥60% | **'''[[Bone marrow]] [[plasma cell]] burden''': Clonal [[bone marrow]] [[plasma cell]] percentage ≥60% | ||
**'''[[Light chain|Free light chain]] ratio''': Involved-to-uninvolved free [[light chain]] ratio ≥100 | **'''[[Light chain|Free light chain]] ratio''': Involved-to-uninvolved free [[light chain]] ratio ≥100 | ||
**'''[[MRI]]''': >1 focal [[Bone|bony]] [[lesion]] of 5mm or greater on [[MRI]] studies | **'''[[MRI]]''': >1 focal [[Bone|bony]] [[lesion]] of 5mm or greater on [[MRI]] studies | ||
{| | {| | ||
| | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Revised Criteria for the Diagnosis of Multiple Myeloma | ||
|- | |- | ||
| | | align="left" style="background:#F5F5F5;" + | | ||
*≥10% clonal [[plasma cells]] in [[bone marrow]] | *≥10% clonal [[plasma cells]] in [[bone marrow]] | ||
'''OR''' | '''OR''' | ||
* | *Biopsy-proven bony or [[Plasmacytoma|extramedullary plasmacytoma]] with one or more of the following: | ||
**'''[[Hypercalcemia]]''': [[Calcium|serum calcium]] >0·25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2·75 mmol/L (>11 mg/dL) | |||
* '''[[Hypercalcemia]]''': [[Calcium|serum calcium]] >0·25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2·75 mmol/L (>11 mg/dL) | **'''[[Renal insufficiency]]''': [[creatinine]] clearance <40 mL per min or [[serum creatinine]] >177 μmol/L (>2 mg/dL) | ||
**'''[[Anemia]]''': [[hemoglobin]] value of >2 g/dL below the lower limit of normal, or a [[hemoglobin]] value <10 g/dL | |||
*'''[[Renal insufficiency]]''': [[creatinine]] clearance <40 mL per min or [[serum creatinine]] >177 μmol/L (>2 mg/dL) | **'''[[Bone]] [[lesion]]''': one or more osteolytic [[lesions]] on [[Skeleton|skeletal]] [[radiography]], [[CT-scans|CT]], or [[PET scan|PET-CT]] | ||
*'''[[Anemia]]''': [[hemoglobin]] value of >2 g/dL below the lower limit of normal, or a [[hemoglobin]] value <10 g/dL | **'''[[Bone marrow]] [[plasma cell]] burden''': Clonal [[bone marrow]] [[plasma cell]] percentage ≥60% | ||
*'''[[Bone]] [[lesion]]''': one or more osteolytic [[lesions]] on [[Skeleton|skeletal]] [[radiography]], [[CT-scans|CT]], or [[PET scan|PET-CT]] | **'''[[Light chain|Free light chain]] ratio''': Involved-to-uninvolved free [[light chain]] ratio ≥100 | ||
**'''[[MRI]]''': >1 focal [[Bone|bony]] [[lesion]] of 5mm or greater on [[MRI]] studies | |||
*'''[[Bone marrow]] [[plasma cell]] burden''': Clonal [[bone marrow]] [[plasma cell]] percentage ≥60% | |||
*'''[[Light chain|Free light chain]] ratio''': Involved-to-uninvolved free [[light chain]] ratio ≥100 | |||
*'''[[MRI]]''': >1 focal [[Bone|bony]] [[lesion]] of 5mm or greater on [[MRI]] studies | |||
|} | |} | ||
===Criteria for the Diagnosis of Monoclonal Gammopathy of Undetermined Significance (MGUS)=== | ===Criteria for the Diagnosis of Monoclonal Gammopathy of Undetermined Significance (MGUS)=== | ||
All three criteria must be met: | All three criteria must be met:<ref name="lancet">Rajkumar, S. Vincent, Meletios A. Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar et al. "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma." The Lancet Oncology 15, no. 12 (2014): e538-e548</ref><ref name="pmid18971951">{{cite journal |vauthors=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |date=January 2009 |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=}}</ref><ref name="pmid12780789">{{cite journal |vauthors= |title=Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group |journal=Br. J. Haematol. |volume=121 |issue=5 |pages=749–57 |date=June 2003 |pmid=12780789 |doi= |url=}}</ref> | ||
* Presence of serum monoclonal [[protein]] ([[IgG]] or [[IgA]]) <3 g/dL | * Presence of serum monoclonal [[protein]] ([[IgG]] or [[IgA]]) <3 g/dL | ||
* Presence of [[bone marrow]] clonal [[plasma cells]] <10% | * Presence of [[bone marrow]] clonal [[plasma cells]] <10% | ||
| Line 50: | Line 46: | ||
===Criteria for the Diagnosis of Smoldering Multiple Myeloma=== | ===Criteria for the Diagnosis of Smoldering Multiple Myeloma=== | ||
Both criteria must be met<ref name="lancet">Rajkumar, S. Vincent, Meletios A. Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar et al. "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma." The Lancet Oncology 15, no. 12 (2014): e538-e548</ref> | Both criteria must be met:<ref name="lancet">Rajkumar, S. Vincent, Meletios A. Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar et al. "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma." The Lancet Oncology 15, no. 12 (2014): e538-e548</ref><ref name="pmid18971951">{{cite journal |vauthors=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |date=January 2009 |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=}}</ref> | ||
* Serum monoclonal [[protein]] ([[IgG]] or [[IgA]]) ≥3 g/dL or [[urinary]] monoclonal [[protein]] ≥500 mg per 24 h and/or clonal [[bone marrow]] [[plasma cells]] 10–60% | * Serum monoclonal [[protein]] ([[IgG]] or [[IgA]]) ≥3 g/dL or [[urinary]] monoclonal [[protein]] ≥500 mg per 24 h and/or clonal [[bone marrow]] [[plasma cells]] 10–60% | ||
* Absence of [[multiple myeloma]]-defining events or [[amyloidosis]] | * Absence of [[multiple myeloma]]-defining events or [[amyloidosis]] | ||
=== Criteria for the Diagnosis of Solitary Plasmacytoma === | |||
All four [[criteria]] must be met:<ref name="pmid18971951">{{cite journal |vauthors=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |date=January 2009 |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=}}</ref> | |||
* [[Biopsy]]-proven [[solitary]] [[lesion]] of [[bone]] or [[soft tissue]] with evidence of clonal [[plasma cells]] | |||
* Normal [[bone marrow]] with no evidence of clonal [[plasma cells]] | |||
* Normal [[skeletal survey]] and [[MRI]] of [[spine]] and [[pelvis]] (except for the primary [[solitary]] [[lesion]]) | |||
* No evidence of [[End organ damage|end-organ damage]] such as CRAB [[lesions]] that can be attributed to a lymphoplasma cell proliferative [[disorder]] | |||
==References== | ==References== | ||
{{Reflist| | {{Reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Hematology]] | |||
[[Category:Neurology]] | |||
[[Category:Neurosurgery]] | |||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Surgery]] | |||
Latest revision as of 22:46, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Serge Korjian M.D.; Shyam Patel [3]
Overview
The diagnosis of monoclonal gammopathy of undetermined significance requires the presence of clonal plasma cells < 10% and serum monoclonal protein <3g/dl but the absence of end-organ damage. The diagnosis of smoldering multiple myeloma requires the presence of clonal plasma cells 10%-60% and serum monoclonal protein >3g/dl but the absence of end-organ damage. The diagnosis of active multiple myeloma requires the presence of end-organ damage. In November 2014, the International Myeloma Working Group (IMWG) updated the criteria for the diagnosis of multiple myeloma to include novel validated biomarkers to better encompass the extent of disease. Prior to 2014, the original diagnostic criteria for end-organ damage included CRAB features (hypercalcemia, renal failure, anemia, and bone lesions) without consideration of the plasma cell burden or free light chain ratio. The 2014 update also clarified the underlying laboratory and radiographic findings of CRAB features, as well as the histological and monoclonal protein requirements for the disease diagnosis.[1]
Diagnostic Criteria
Revised Criteria for the Diagnosis of Multiple Myeloma
The diagnosis of multiple myeloma requires the following:[1][2][3][4]
- ≥10% clonal plasma cells in bone marrow
OR
- biopsy-proven bony or extramedullary plasmacytoma,
With one or more of the myeloma-defining events:
- CRAB features:
- Hypercalcemia: serum calcium >0·25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2·75 mmol/L (>11 mg/dL)
- Renal insufficiency: creatinine clearance <40 mL per min or serum creatinine >177 μmol/L (>2 mg/dL)
- Anemia: hemoglobin value of >2 g/dL below the lower limit of normal, or a hemoglobin value <10 g/dL
- Bone lesion: one or more osteolytic lesions on skeletal radiography, CT, or PET-CT
- Biomarkers of malignancy:
- Bone marrow plasma cell burden: Clonal bone marrow plasma cell percentage ≥60%
- Free light chain ratio: Involved-to-uninvolved free light chain ratio ≥100
- MRI: >1 focal bony lesion of 5mm or greater on MRI studies
| Revised Criteria for the Diagnosis of Multiple Myeloma |
|---|
OR
|
Criteria for the Diagnosis of Monoclonal Gammopathy of Undetermined Significance (MGUS)
All three criteria must be met:[1][2][3]
- Presence of serum monoclonal protein (IgG or IgA) <3 g/dL
- Presence of bone marrow clonal plasma cells <10%
- Absence of multiple myeloma-defining events or amyloidosis
Criteria for the Diagnosis of Smoldering Multiple Myeloma
Both criteria must be met:[1][2]
- Serum monoclonal protein (IgG or IgA) ≥3 g/dL or urinary monoclonal protein ≥500 mg per 24 h and/or clonal bone marrow plasma cells 10–60%
- Absence of multiple myeloma-defining events or amyloidosis
Criteria for the Diagnosis of Solitary Plasmacytoma
All four criteria must be met:[2]
- Biopsy-proven solitary lesion of bone or soft tissue with evidence of clonal plasma cells
- Normal bone marrow with no evidence of clonal plasma cells
- Normal skeletal survey and MRI of spine and pelvis (except for the primary solitary lesion)
- No evidence of end-organ damage such as CRAB lesions that can be attributed to a lymphoplasma cell proliferative disorder
References
- ↑ 1.0 1.1 1.2 1.3 Rajkumar, S. Vincent, Meletios A. Dimopoulos, Antonio Palumbo, Joan Blade, Giampaolo Merlini, María-Victoria Mateos, Shaji Kumar et al. "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma." The Lancet Oncology 15, no. 12 (2014): e538-e548
- ↑ 2.0 2.1 2.2 2.3 Kyle RA, Rajkumar SV (January 2009). "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma". Leukemia. 23 (1): 3–9. doi:10.1038/leu.2008.291. PMC 2627786. PMID 18971951.
- ↑ 3.0 3.1 "Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group". Br. J. Haematol. 121 (5): 749–57. June 2003. PMID 12780789.
- ↑ Rajkumar SV, Kyle RA (October 2005). "Multiple myeloma: diagnosis and treatment". Mayo Clin. Proc. 80 (10): 1371–82. doi:10.4065/80.10.1371. PMID 16212152.