A recent article in Leukemia features an updated list of diagnostic criteria for multiple myeloma.

The list, developed primarily by the International Myeloma Working Group (IMWG), provides three main criteria that must be met in order to diagnose multiple myeloma. They are as follows:

• Abnormal clonal plasma cells present in the bone marrow

• Monoclonal protein present in the urine and/or blood serum

• Evidence of end-organ damage such as bone lesions, anemia, renal insufficiency, and hypercalcemia.

The end-organ damage must be linked to multiple myeloma, and cannot be caused by any other disease or disorder in order to count toward diagnosis.

The list also provides criteria for diagnosing other plasma cell disorders, which helps one differentiate multiple myeloma from seemingly similar conditions.

In some cases, the only criteria that separates the diagnosis of multiple myeloma from another disorder, like asymptomatic multiple myeloma or monoclonal gammopathy of undetermined significance (MGUS), is the presence of end-organ damage.

Skeletal lesions, a common manifestation of end-organ damage, can be detected through imaging procedures like MRI, fluoro-deoxyglucose positron emission tomography (PET), and computed tomography (CT). The lesions may also show up in asymptomatic myeloma patients as tumor-related abnormalities on the lower spine.

The authors of the article warn that the role of these imaging techniques in diagnosis still needs further investigation. They say that asymptomatic lesions detected only through MRI, CT, or PET scanning should not be considered a basis for therapy, but rather, that therapeutic decisions should be made on a case-by-case basis.

For more information, visit the full article. Future installments detailing new information on staging, risk stratification, and response criteria in multiple myeloma will follow in the coming weeks.