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Table 2. Diagnostic Criteria for Active Multiple Myeloma
2014 IMWG Criteria
• Clonal bone marrow plasma cells ≥10% or biopsy-proven bone or extramedullary
plasmacytoma
• Any one or more of the following myeloma-defining events (attributed to the plasma
cells)
▶ Hypercalcemia (greater than upper limit of normal)
▶ Renal insufficiency: Serum creatinine >2 g/dL or creatinine clearance <40 ml/min
▶ Anemia: Hemoglobin <10 gm/dL or >2 gm/dL below lower limit of normal
▶ Bone lesions: one or more osteolytic lesions (as demonstrated on imaging studies)
NEW Additional Criteria
• Involved/uninvolved serum free light chains ratio ≥100, and the involved serum free
light chain level ≥100 mg/dL
• Clonal bone marrow plasma cells ≥60%
• Two or more focal lesions based on MRI studies of the skeleton
Note: Adapted with permission from Rajkumar 2014.
Table 3. Revised International Staging System (R-ISS)
• Stage I: ISS Stage I (β2-M <3.5 mg/L and serum albumin ≥3.5 g/dL) AND normal
LDH, no abnormal FISH
• Stage II: Neither Stage 1 or Stage III
• Stage III: β2-M >5.5 mg/L AND elevated serum LDH, or abnormal FISH: presence
of t(4, 14), t(14, 20), or 17p deletion
Note: Adapted with permission from Palumbo 2015
