{"id":10205,"date":"2023-11-17T19:33:13","date_gmt":"2023-11-17T19:33:13","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=10205"},"modified":"2025-12-30T19:12:12","modified_gmt":"2025-12-30T19:12:12","slug":"imwg-myeloma-and-related-plasma-cell-disorders","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/imwg-myeloma-and-related-plasma-cell-disorders\/","title":{"rendered":"IMWG Diagnostic Criteria for Multiple Myeloma and Related Plasma Cell Disorders"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Plasma cell neoplasms including multiple myeloma (MM) and related terminally differentiated B-cell neoplasms are characterized by secretion of monoclonal immunoglobulin and stepwise development from a preneoplastic clonal B and\/or plasma cell proliferation called monoclonal gammopathy of undetermined significance (MGUS). Diagnosis of these disorders requires integration of clinical, laboratory, and morphological features.<!--more--><\/p>\n<p><strong>International Myeloma Working Group Diagnostic Criteria for Multiple Myeloma and Related Plasma Cell Disorders<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>Disorder<\/strong><\/td>\n<td style=\"width: 77.9431%;\"><strong>Disease Definition<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>Non-IgM MGUS<\/strong><\/td>\n<td style=\"width: 77.9431%;\">All three criteria must be met:<\/p>\n<ul>\n<li>Serum monoclonal protein (non-IgM type) &lt; 3 g\/dL<\/li>\n<li>Clonal bone marrow plasma cells &lt; 10%*<\/li>\n<li>Absence of end-organ damage such as CRAB features that can be attributed to the plasma cell proliferative disorder<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>Smoldering MM<\/strong><\/td>\n<td style=\"width: 77.9431%;\">Both criteria must be met:<\/p>\n<ul>\n<li>Serum monoclonal protein (IgG or IgA) \u2265 3 gm\/dL, or urinary monoclonal protein \u2265 500 mg per 24 h and\/or clonal bone marrow plasma cells 10%\u201360%<\/li>\n<li>Absence of myeloma-defining events or amyloidosis<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>MM<\/strong><\/td>\n<td style=\"width: 77.9431%;\">Both criteria must be met:<\/p>\n<ul>\n<li>Clonal bone marrow plasma cells \u2265 10% or biopsy-proven bony or extramedullary plasmacytoma<\/li>\n<li>Any one or more of the following myeloma defining events:\n<ul>\n<li>Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically:\n<ul>\n<li>Hypercalcemia: serum calcium &gt; 0.25 mmol\/L (&gt; 1 mg\/dL) higher than the upper limit of normal or &gt; 2.75 mmol\/L (&gt; 11 mg\/dL)<\/li>\n<li>Renal insufficiency: creatinine clearance &lt; 40 mL\/min or serum creatinine &gt; 177 mmol\/L (&gt; 2 mg\/dL)<\/li>\n<li>Anemia: hemoglobin value of &gt; 2 g\/dL below the lower limit of normal, or a hemoglobin value &lt; 10 g\/dL<\/li>\n<li>Bone lesions: one or more osteolytic lesions on skeletal radiography, CT, or PET-CT<\/li>\n<\/ul>\n<\/li>\n<li>Clonal bone marrow plasma cell percentage \u2265 60%<\/li>\n<li>Involved: uninvolved serum FLC ratio \u2265 100 (involved FLC level must be \u2265 100 mg\/L)<\/li>\n<li>&gt; 1 focal lesion on MRI studies (at least 5 mm in size)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>IgM MGUS<\/strong><\/td>\n<td style=\"width: 77.9431%;\">All three criteria must be met:<\/p>\n<ul>\n<li>Serum IgM monoclonal protein &lt; 3 g\/dL<\/li>\n<li>Bone marrow lymphoplasmacytic infiltration &lt; 10%<\/li>\n<li>No evidence of anemia, constitutional symptoms, hyperviscosity, lymphadenopathy, or hepatosplenomegaly that can be attributed to the underlying lymphoproliferative disorder.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>Light-Chain MGUS<\/strong><\/td>\n<td style=\"width: 77.9431%;\">All criteria must be met:<\/p>\n<ul>\n<li>Abnormal FLC ratio (&lt; 0.26 or &gt; 1.65)<\/li>\n<li>Increased level of the appropriate involved light chain (increased kappa FLC in patients with ratio &gt; 1.65 and increased lambda FLC in patients with ratio &lt; 0.26)<\/li>\n<li>No immunoglobulin heavy-chain expression on immunofixation<\/li>\n<li>Absence of end-organ damage that can be attributed to the plasma cell proliferative disorder<\/li>\n<li>Clonal bone marrow plasma cells &lt; 10%<\/li>\n<li>Urinary monoclonal protein &lt; 500 mg\/24 h<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>Solitary Plasmacytoma<\/strong><\/td>\n<td style=\"width: 77.9431%;\">All four criteria must be met:<\/p>\n<ul>\n<li>Biopsy-proven solitary lesion of bone or soft tissue with evidence of clonal plasma cells<\/li>\n<li>Normal bone marrow with no evidence of clonal plasma cells<\/li>\n<li>Normal skeletal survey and MRI (or CT) of spine and pelvis (except for the primary solitary lesion)<\/li>\n<li>Absence of end-organ damage such as CRAB features that can be attributed to a lympho-plasma cell proliferative disorder<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.0569%;\"><strong>Solitary Plasmacytoma With Minimal <\/strong><strong>Marrow Involvement**<\/strong><\/td>\n<td style=\"width: 77.9431%;\">All four criteria must be met:<\/p>\n<ul>\n<li>Biopsy-proven solitary lesion of bone or soft tissue with evidence of clonal plasma cells<\/li>\n<li>Clonal bone marrow plasma cells &lt; 10%<\/li>\n<li>Normal skeletal survey and MRI (or CT) of spine and pelvis (except for the primary solitary lesion)<\/li>\n<li>Absence of end-organ damage such as CRAB features that can be attributed to a lympho-plasma cell proliferative disorder<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Abbreviations: MGUS, monoclonal gammopathy of undertermined significance; CRAB features, hypercalcemia, renalinsufficiency, anemia, and bone lesions; MM, multiple myeloma; FLC, freelight chain; SMM, smoldering multiple myeloma.<br \/>\n*A bone marrow examination can be deferred for patients with low-risk MGUS (IgG type, M protein &lt; 15 g\/L, normal FLC ratio) in whom there are no clinical features concerning for myeloma.<br \/>\n**Solitary plasmacytoma with 10% or more clonal plasma cells is considered as MM.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Fend F, Dogan A, Cook JR. Plasma cell neoplasms and related entities-evolution in diagnosis and classification. Virchows Arch. 2023 Jan;482(1):163-177. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36414803\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Rajkumar SV. Updated Diagnostic Criteria and Staging System for Multiple Myeloma. Am Soc Clin Oncol Educ Book. 2016;35:e418-23. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27249749\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Nov 14, 2023.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[171],"tags":[757,756,16,15,14,13,939,2015,755,469,754,752,758,1563],"class_list":["post-10205","post","type-post","status-publish","format-standard","hentry","category-hematology","tag-cell","tag-celulas","tag-criteria","tag-criterios","tag-diagnostic","tag-diagnostico","tag-disorders","tag-imwg","tag-mieloma","tag-multiple","tag-myeloma","tag-plasma","tag-plasmaticas","tag-related"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/10205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=10205"}],"version-history":[{"count":11,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/10205\/revisions"}],"predecessor-version":[{"id":10222,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/10205\/revisions\/10222"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=10205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=10205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=10205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}