Monitoring Patients with M-Proteins
Low level
Intermediate level
Higher level
Follow up testing
Serum M-Protein
Serum M-Protein
Serum M-Protein
is recommended
if monoclonal 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
is discovered
in the serum / urine
Bone marrow
Optional
Perform if
Perform if
< 10% Plasma Cells
> 10% Plasma Cells
are present
are present
Probable MGUS
Check for presence of CRAB criteria
Follow every 3-4 months for 2 years
and then once a year if no progression
Recommended testing:
C ­ Calcium increased > 10.5 mg/dL
· SPEP + UPEP1
(SPEP = Serum Protein Electrophoresis +
R ­ Renal insuciency: creatinine > 2 mg/dL
UPEP = Urine Protein Electrophoresis)
A ­ Anemia: Hb < 10 g/dL -- Can be < 2 g below normal
· Serum free light chain
B ­ Documented Bone lesions or Bone involvement
· CRAB tests
Smoldering or
Clinical
Symptomatic Myeloma
Asymptomatic Myeloma
signs
Proceed to Staging
Proceed to Risk Assessment
Durie-Salmon Classification
A
Stage I
Stage II
Stage III
serum
· Hb > 10 g/dL
· neither I nor III
· Hb < 8.5 g/dL
creatinine
· normal calcium
· high calcium
< 2 mg/dL
· normal or single
>12 mg/dL
plasmacytoma
· 3 or more lytic
B
or osteoporosis
bone lesions
serum
· SPEP & UPEP
creatinine
· SPEP & UPEP
(peak quantitation):
> 2 mg/dL
(peak quantitation):
· IgG < 5 g/dL
· IgG > 7 g/dL
· IgA < 3 g/dL
· IgA > 5 g/dL
· BJP < 4 g/24h*
· BJP > 12 g/24h*
ISS (International Staging System)
* BJP = Bence Jones Protein,
Stage I
Stage II
Stage III
a myeloma monoclonal protein
Complementary tests
2M < 3.5 mg/L and
present in urine. The amount
At least one abnormal result
2M < 3.5 mg/L
2M > 5.5 mg/L
Alb < 3.5 g/dL or
of BJP is expressed in terms
No abnormalities
Alb 3.5 g/dL
Alb < 3.5 g/dL
of grams per 24 hours.
2M 3.5­5.5 mg/L
Referral for Treatment
If testing confirms Active or Symptomatic Myeloma,
refer to MD for Treatment
1 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.

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