Multiple Myeloma Diagnosis Criteria

Multiple myeloma diagnosis criteria - multiple myeloma diagnostic criteria - Diagnostic criteria for multiple myeloma help doctors to evaluate and diagnose disease based on laboratory test results diagnostic test. Diagnostic tests can be performed on samples of blood, urine, bone and bone marrow, to determine whether these criteria. This test is performed not only to determine the presence of multiple myeloma, but also to assess the level of disease. Thus, the test is also useful for the classification and stage of multiple myeloma. Diagnostic criteria for multiple myeloma requires confirmation of one major criteria and one criteria Junior or the criteria of people who have signs or symptoms of multiple myeloma.
Multiple Myeloma Diagnosis Criteria

The main criteria
  • Plasmacytoma (as demonstrated in the evaluation of biopsy specimen)
  • 30% plasma cells in samples of bone marrow
  • Implement levels of M protein in the blood or urine

Minor criteria
  • 10% to 30% plasma cells in samples of bone marrow.
  • Minor increase in the levels of M protein in the blood or urine.
  • The lesion osteolitik (as shown in the picture study).
  • The level of antibodies is low (not produced by cancer cells) in the blood.

CountDefinitionNormal Range*
Number of red blood cells in the blood. Red blood cells bring oxygen from the lungs to the various tissues in the body and carry carbon dioxide back to the lungs. Low numbers of red blood cells or low hemoglobin or hematocrit indicate anemia, which can cause physical and mental fatigueFemale 4.1-5.1 x 1012/L
Male 4.5-5.3 x 1012/L
Oxygen-carrying substance in red blood cellsFemale 12 – 16 g/dL
Male 13 – 18 g/dL
Percentage of red blood cells in the blood.Female 36 – 46%
Male 37 – 49%
Number of white blood cells in the blood; counts or percentages of the individual types of blood cells are also provided. White blood cells help fight infection and remove harmful substances from the body. A low number of white cells can increase the possibility of infectionTotal 3.5 – 10.5 x 109/L
Neutrophils 1.7 – 7.0
Monocytes 0.3 – 0.9
Lymphocytes0.9 – 2.9
Basophils 0.0 – 0.3
Eosinophils 0.05 – 0.5
PlateletsNumber of platelets in the blood. Because platelets help blood to clot, low counts can lead to excessive bleeding150 – 450 x 109/L
*Normal ranges may vary.
Source: Themmrf
See also: Multiple Myeloma Diagnosis and Treatment

Multiple Myeloma Diagnosis Criteria

Multiple myeloma diagnostic criteria - The main diagnostic criteria of multiple myeloma are: detection of plasmacytoma in tissue biopsy; over 30% plasma cells in the bone marrow (in most cases with signs of anaplasia, in particular multicore plasma cells); the presence of μ-gradients in the serum (> 35 g/l or IgG > 20 g/l for IgA) or in daily urine (> 10 g per day). Minor diagnostic criteria are: 10...30% plasma cells in the bone marrow; detection of μ-gradient, however, the below mentioned indicators; the presence of foci of osteolysis; the definition of residual, sharply reduced concentrations of the normal serum immunoglobulins (IgM < 0.5 g/l, IgA < 1.0 g/l or IgG < 6.0 g/l depending on the class of paraprotein). In addition to the characteristic clinical picture, the diagnosis of multiple myeloma based on the presence of at least one major and one minor criteria or at least three criteria of the second order, but subject to mandatory identification of μ-gradient, and plasmacytosis bone marrow.
The paraprotein in the blood and urine is determined mostly by electrophoresis, however, the more accurate is the method of immunofixation, allowing to identify the paraprotein in the blood at a dose of 0.2 g/l, and in urine, in the dose of 0.04 g/l, despite normal results in the study of proteins by electrophoresis or normal levels of immunoglobulins in the serum. Especially valuable this method is in tracking treatment results, in particular, a complete response to treatment.

The international group for the study of myeloma, led by Durie and Kyle, for the diagnosis of multiple myeloma considers sufficient the presence of only 3 criteria.

Diagnostic criteria for multiple myeloma

Large criteria:
  • the presence of plasma cells in the biopsy tissue
  • the plasma cells in bone marrow > 30 %
  • monoclonal protein in the serum: > 35,0 g/l IgG, > 20.0 g/l IgA, ≥ 1.0 g/24 h κ or λ light chains in the urine (proteinuria Bence-Jones)

Small criteria:
  • the plasma cells in the bone marrow 10-30 %
  • monoclonal protein in smaller quantities than criteria large
  • foci of osteolysis in the bone
  • the normal content of immunoglobulins: IgM <0.5 g/l; IgA < 1.0 g/l; IgG < 6.0 g/L.

Confirmation of diagnosis:
Criterion 1 large + 1 small criterion 3 or criterion of small, but definitely 1st + 2nd. Diagnostic criteria of multiple myeloma:
  • the plasma cells in the bone marrow ≥ 10% or plasmacytoma presence in biopsy tissues
  • the presence of monoclonal protein in blood or urine (in the absence requires the presence of ≥ 30% plasma cells in the bone marrow)
  • one of the associated with multiple myeloma signs of dysfunction of organs:
  • hypercalcemia > 105 mg/l
  • increase in creatinine > 20 mg/l
  • a decrease in hemoglobin < 100 g/l
  • the presence of osteoporosis or lytic lesions of bone*. 
  • *If you have a solitary plasmacytoma or osteoporosis (without fractures) requires the presence of ≥ 30% plasma cells in the bone marrow.

According to clinical symptoms and laboratory data distinguish indolent (Indolent) and smoldering (Smoldering) myeloma, which correspond to stage IA according to the Durie-Salmon.

Criteria for diagnosis of MGUS, smoldering and indolent myeloma

Indolent myeloma (Indolent):
  • plasmocytes bone marrow >30 %
  • no bone lesions or limited bone lesions
  • (≤3 lytic lesions) no compression fractures
  • the level of paraprotein or m-component: IgG ≤70 g/l, IgA ≤50 g/l
  • the absence of symptoms or signs of associated disease: General condition (performance status) >70 %, hemoglobin >100 g/l, serum calcium - normal, serum creatinine <20 mg/l, the lack of infections. 

Smoldering myeloma (Smoldering):
  • the criteria are the same as indolent myeloma except:
  • the absence of bone lesions ≤30 %, but >10% plasma cells in the bone marrow.

Monoclonal gammapathy uncertain origin (MGUS):
  • the level of paraprotein or m-component: IgG in blood ≤30 g/l, IgA in the blood of ≤20 g/l, BJ protein in urine is ≤1 g/24 h
  • <10% plasma cells in the bone marrow
  • the absence of bone lesions and other symptoms associated with the disease, especially anemia, hypercalcemia, renal failure
  • the absence of clinical and laboratory signs of amyloidosis or disease deposits of light chains of immunoglobulins.

Multiple Myeloma Diagnostic Criteria

These concepts are United by the presence of a monoclonal paraprotein in blood and/or urine monoclonal plasma cells in the bone marrow and/or tissue biopsy, in the absence of myeloma-related disorders such as: calcium > 2.75 mm/l, hemoglobin < 100 g/l, creatinine > 173 mm/l, and also lytic, and osteoporotic bone lesions, hyperviscosity syndrome, amyloidosis, recurrent bacterial infections (more than 2 times per year).

Even more important is the concept of monoclonal gammopathy of unknown significance (MGUS), an asymptomatic monoclonal uniting of gammapathy, plasmacytosis bone marrow < 10% and a certain level of µ-gradient in the blood (IgG < 35 g/l, IgA < 20g/l) or in urine (proteinuria Bence-Jones < 1 g/day). There are no signs of damage to the skeleton, must be normal levels of hemoglobin, creatinine and calcium in the blood. Finally to differentiate the monoclonal gammapathy unknown value IA and stage of multiple myeloma, one should resort to dynamic observation (not less than one year) with regular concentrations of paraprotein. As shown by numerous long-term research, the risk of transformation of MGUS to myeloma or other lymphoproliferative processes cash paraprotein in 10 years is 15-20 %, 20-25 years - 30-40 %: the risk of transformation correlates with the content of the paraprotein from patient first diagnosed with MGUS. Overall, approximately 1/4 of patients with MGUS in the future ill active myeloma, macroglobulinemia, amyloidosis, or other lymphoproliferative diseases.

It should be remembered that the secretion of paraprotein in addition to plasma cell tumors (multiple myeloma, solitary bone and extramedullary plasmacytoma, waldenstrom's macroglobulinemia, heavy chain disease), often found in other lymphoproliferative processes (chronic lympholeukemia, non-Hodgkin's lymphoma), systemic connective tissue diseases, primary amyloidosis, cancers (colon, lung, prostate), liver problems, sarcoidosis, Gaucher's disease, Sjogren's syndrome, disease cold agglutinins.

It is important to differentiate monoclonal of origin gammapathy tumor or potentially tumor and polyclonal (secretion of both types of light chains) that occur predominantly in inflammatory or reactive processes.

In many diseases (cancer, autoimmune and inflammatory disorders, hepatitis), there is a jet of plasma cell reaction in the bone marrow, which, unlike myeloma, is often not combined with the presence of paraprotein (often accompanied by polyclonal hyperglobulinemia).

Multiple myeloma must be differentiated from metastatic bone disease, fibrous osteodystrophy (Recklinghausen's disease), Paget's disease, bone angiom. In the absence of pathognomonic changes in proteinogram proteins in the blood and urine of such patients should resort to biopsy the bone lesion.

When secretiruema rare form of multiple myeloma the paraprotein can be identified only in the tumor cells, although sufficiently characteristic remains the reduction of normal immunoglobulins in the serum. Frequent diagnostic errors in the detection of myeloma Bence-Jones, when secreted monoclonal light chains of immunoglobulins: all patients with unexplained proteinuria should be carried out electrophoresis of urine proteins.

To the group of plasma cell tumors include solitary plasmacytoma of bone, of extramedullary plasmacytoma, multiple (±recurrent) solitary plasmacytoma as bones and soft tissues: they all share the lack of involvement of the bone marrow, the serum paraprotein and urine, and other lesions of the skeleton and the clinical manifestations associated with the disease primarily, anemia, hypercalcemia, renal failure, despite clear histological evidence of plasma cell tumors.

Isolated plasma cell leukemia, which finds subject to ≥ 2.0 x 109/l plasma cells in peripheral blood and > 20% plasma cells in the bone marrow. Unlike secondary "licensebanner" forms, primary plasma cell leukemia occur in