Multiple myeloma diagnostic criteria

Revised and latest Multiple myeloma diagnostic criteria [ Revised International Myeloma Working Group (IMWG) ]
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:sparkle:The revised IMWG criteria allow, in addition to the classic CRAB features, three “myeloma defining events” (MDEs).

:eight_spoked_asterisk:The presence of at least one of these markers is considered sufficient for a diagnosis of multiple myeloma, regardless of the presence or absence of symptoms or CRAB features.

:sparkle: Each of these markers has been associated with an approximately 80% or higher risk of developing myeloma-related organ damage within two years.

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The new definition of active multiple myeloma is:

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:white_check_mark:Clonal bone marrow plasma cells ≥10% or biopsy-proven bony or extramedullary plasmacytoma and any one or more of the following CRAB features and myeloma-defining events:

  1. Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically:
    A) Hypercalcemia: serum calcium >0.25 mmol/L (>1mg/dL) higher than the upper limit of normal or >2.75 mmol/L (>11mg/dL)

B ) Renal insufficiency: creatinine clearance <40 mL per minute or serum creatinine >177µmol/L (>2mg/dL).

C ) Anemia: hemoglobin valure of >20g/L below the lowest limit of normal, or a hemoglobin value <100g/L

D)Bone lesions: one or more osteolytic lesion on skeletal radiography, CT, or PET/CT.

:white_check_mark: If bone marrow has <10% clonal plasma cells, more than one bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement.

:white_check_mark: Any one or more of the following biomarkers of malignancy (MDEs ;Myeloma Defining Events):

  1. 60% or greater clonal plasma cells on bone marrow examination.

  2. Serum involved / uninvolved free light chain ratio of 100 or greater, provided the absolute level of the involved light chain is at least 100mg/L (a patient’s “involved” free light chain—either kappa or lambda—is the one that is above the normal reference range; the “uninvolved” free light chain is the one that is typically in, or below, the normal range).

  3. More than one focal lesion on MRI that is at least 5mm or greater in size.