Monitoring Patients with M-Proteins

Low level
Serum M-Protein

Intermediate level
Serum M-Protein

Higher level
Serum M-Protein

SPEP M-spike level < 1.5 g/dL

SPEP M-spike level > 1.5 g/dL but < 3.0 g/dL

SPEP M-spike level > 3.0 g/dL

Follow up testing
is recommended
if monoclonal protein
is discovered
in the serum / urine

Bone marrow
Optional

Perform if
< 10% Plasma Cells
are present

Perform if
> 10% Plasma Cells
are present

Check for presence of CRAB criteria

Probable MGUS
Follow every 3-4 months for 2 years
and then once a year if no progression
Recommended testing:
SPEP + UPEP1
(SPEP = Serum Protein Electrophoresis +
UPEP = Urine Protein Electrophoresis)
Serum free light chain
CRAB tests

C Calcium increased > 10.5 mg/dL

R Renal insufficiency: creatinine > 2 mg/dL
A Anemia: Hb < 10 g/dL Can be < 2 g below normal
B Documented Bone lesions or Bone involvement

Smoldering or
Asymptomatic Myeloma
Proceed to Risk Assessment

Clinical
signs

Symptomatic Myeloma
Proceed to Staging

Durie-Salmon Classification
A
serum
creatinine
< 2 mg/dL
B
serum
creatinine
> 2 mg/dL

Complementary tests
At least one abnormal result
No abnormalities

Stage I
Hb > 10 g/dL
normal calcium
normal or single
plasmacytoma
or osteoporosis
SPEP & UPEP
(peak quantitation):
IgG < 5 g/dL
IgA < 3 g/dL
BJP < 4 g/24h*

Stage II
neither I nor III

ISS (International Staging System)

Stage I
Stage II
Stage III
2M
<
3.5
mg/L
and
2M < 3.5 mg/L
2M > 5.5 mg/L
Alb < 3.5 g/dL or
Alb 3.5 g/dL
Alb < 3.5 g/dL
2M 3.55.5 mg/L

Stage III
Hb < 8.5 g/dL
high calcium
>12 mg/dL
3 or more lytic
bone lesions
SPEP & UPEP
(peak quantitation):
IgG > 7 g/dL
IgA > 5 g/dL
BJP > 12 g/24h*
* BJP = Bence Jones Protein,
a myeloma monoclonal protein
present in urine. The amount
of BJP is expressed in terms
of grams per 24 hours.

Referral for Treatment

If testing confirms Active or Symptomatic Myeloma,
refer to MD for Treatment

Electrophoresis is the most reliable indicator for M-spike progression

2010 International Myeloma Foundation

References are available, see the IMWG Guidelines
at www.myeloma.org.