Multiple myeloma diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnostic Criteria

In November 2014, the International Myeloma Working Group (IMWG) updated the criteria for the diagnosis of multiple myeloma (MM) to include novel validated biomarkers that are associated with the development of CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). The 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.

Revised Criteria for the Diagnosis of Multiple Myeloma

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≥10% clonal expansion of bone marrow plasma cells or biopsy-proven bony or extramedullary plasmacytoma and one or more of the following features: Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder: 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 >20 g/L below the lower limit of normal, or a hemoglobin value <100 g/L Bone lesion: one or more osteolytic lesions on skeletal radiography, CT, or PET-CT Any one or more of the following biomarkers of malignancy: Clonal bone marrow plasma cell percentage ≥60% Involved:uninvolved serum free light chain ratio ≥100 >1 focal lesions on MRI studies

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Criteria for the Diagnosis of Smouldering Multiple Myeloma

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Both criteria must be met: Serum monoclonal protein (IgG or IgA) ≥30 g/L or urinary monoclonal protein ≥500 mg per 24 h and/or clonal bone marrow plasma cells 10–60% Absence of myeloma-defining events or amyloidosis

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