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Figure 3:  Classification of Monoclonal Gammopathies

(International Myeloma Working Group)

Diagnosis

Criteria

Monoclonal gammopathy of undetermined significance  (MGUS)

  • M-protein in serum <3 g/dL.
  • Bone marrow clonal plasma cells <10% and low level of plasma cell infiltration in a trephine biopsy (if done).
  • No evidence of other B-cell proliferative disorders.
  • No related organ or tissue impairment (no end organ damage, including bone lesions)a

Asymptomatic (smoldering) myeloma.

  • M-protein in serum  3 g/dL l, and/or:
  • Bone marrow clonal plasma cells 10%.
  • No related organ or tissue impairment (no end organ damage, including bone lesions) or symptoms.a

Symptomatic multiple myeloma.

  • M-protein in serum and/or urine.
  • Bone marrow (clonal) plasma cells or plasmacytoma.
  • Related organ or tissue impairment (end organ damage, including bone lesions).a

Solitary plasmacytoma of bone.

  • No M-protein in serum and/or urine.
  • Single area of bone destruction due to clonal plasma cells.
  • Bone marrow not consistent with multiple myeloma.
  • Normal skeletal survey (and MRI of spine and pelvis if done).
  • No related organ or tissue impairment (no end organ damage other than solitary bone lesion).a

Non-secretory myeloma

  • No M-protein in serum and/or urine with immunofixation.
  • Bone marrow clonal plasmacytosis 10% or plasmacytoma.
  • Related organ or tissue impairment (end organ damage, including bone lesions).a

Extramedullary plasmacytoma.

  • No M-protein in serum and/or urine.a
  • Extramedullary tumor of clonal plasma cells.
  • Normal bone marrow.
  • Normal skeletal survey.
  • No related organ or tissue impairment (end organ damage including bone lesions).a

Multiple solitary plasmacytomas (± recurrent).

  • No M-protein in serum and/or urine.
  • More than one localized area of bone destruction or extramedullary tumor of clonal plasma cells which may be recurrent.
  • Normal bone marrow.
  • Normal skeletal survey and MRI of spine and pelvis if done.
  • No related organ or tissue impairment (no end organ damage other than the localized bone lesions)

Plasma cell leukemia

  • Peripheral blood absolute plasma cell count of at least 2x109/L and more than 20% plasma cells in the peripheral blood differential white cell count.

Note: aMyeloma-related organ or tissue impairment (end organ damage)

  • Calcium levels increased.
  • Renal insufficiency.
  • Anemia.
  • Bone lesions: lytic lesions or osteoporosis with compression fractures (MRI or CT may clarify).
  • Other: symptomatic hyperviscosity, amyloidosis, recurrent bacterial infections (> 2 episodes in 12 months).
  • CRAB (calcium, renal insufficiency, anemia or bone lesions).
  • Some patients may have no symptoms but have related organ or tissue impairment.

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