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.
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.
Count | Definition | Normal Range* |
Erythrocytes (RBCs) | 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 fatigue | Female 4.1-5.1 x 1012/L Male 4.5-5.3 x 1012/L |
Hemoglobin (Hb) | Oxygen-carrying substance in red blood cells | Female 12 – 16 g/dL Male 13 – 18 g/dL |
Hematocrit (HCT) | Percentage of red blood cells in the blood. | Female 36 – 46% Male 37 – 49% |
Leukocytes (WBCs) | 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 infection | Total 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 |
Platelets | Number of platelets in the blood. Because platelets help blood to clot, low counts can lead to excessive bleeding | 150 – 450 x 109/L |
*Normal ranges may vary. |
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.
- 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.
- the criteria are the same as indolent myeloma except:
- the absence of bone lesions ≤30 %, but >10% plasma cells in the bone marrow.
- 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.