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Diagnostic criteria
IMWG diagnostic criteria for plasma cell disorders1
| MGUS | SMM | MM | |
|---|---|---|---|
|
M protein Serum Urine |
<3 gm/dL or <500 mg/24 h |
>3 gm/dL or ≥500 mg/24 h |
N/A |
|
BMPC |
<10% |
10-59% |
≥10%* |
|
Myeloma defining events |
None |
≥1 CRAB symptom or SLiM biomarker |
|
*Or biopsy-proven bone or extramedullary plasmacytoma
SLiM CRAB criteria were established as myeloma defining events by IMWG in 20142
SLiM criteria2
Any one of the following:
- S: ≥60% clonal BMPC
- Li: Involved-to-uninvolved FLC ratio ≥100 and involved FLC ≥10 mg/dL
- M: MRI with >1 focal marrow lesion ≥5 mm in size
CRAB criteria (evidence of organ damage)2
- HyperCalcemia: Calcium >11 mg/dL or 1 mg/dL above ULN
- Renal impairment: Serum creatinine >2 mg/dL or CrCl <40 mL/min
- Anemia: Hemoglobin <10 g/dL or >2 g/dL below LLN
- Bone lesions: ≥1 osteolytic lesion (on WBLDCT or PET scan)
- SLiM criteria may be present without CRAB criteria3
- The presence of SLiM criteria indicates an 80% risk of developing CRAB criteria in the next two years1
- CRAB criteria are not specific to MM3
- Clinical judgement is needed for the differential diagnosis of MM3
BMPC, bone marrow plasma cell; CRAB, hyperCalcemia, Renal impairment, Anemia, Bone lesions; CrCl, creatinine clearance; FLC, free light chain; h, hour; IMWG, International Myeloma Working Group; LLN, lower limit of normal; MGUS, Monoclonal Gammopathy of Unknown Significance; M protein, monoclonal protein; MM, multiple myeloma; MRI, magnetic resonance imaging; N/A, not applicable; PET, positron emission tomograph; SLiM, ≥Sixty-percent (60%) clonal bone marrow plasma cells, Light chain ratio, MRI; SMM, smoldering multiple myeloma; ULN, upper limit of normal; WBLDCT, whole-body low-dose computed tomography.
1. Rajkumar SV, et al. Blood Cancer J. 2022;12(9):129. 2. Rajkumar SV, et al. Lancet Oncol. 2014;15(12):e538-48. 3. Bergstorm DJ, et al. Clin Lymphoma Myeloma Leuk. 2020;20(7):e352-e367.
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