Multiple myeloma screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Shyam Patel [3]

Overview

There is insufficient evidence to recommend routine screening for multiple myeloma in the general population. However, laboratory assessment should be done often (typically once per year or more frequently) for patients who have monoclonal gammopathy of undetermined significance and smoldering multiple myeloma.

Screening

Monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance (MGUS) carries a 1% annual risk (on average) for progression to active multiple myeloma and therefore requires monitoring. Given the risk of progression, patients should be screened via monitoring of complete blood count (CBC), serum protein electrophoresis (SPEP), and free light chain ratio typically once yearly. The frequency of screening may vary depending on the MGUS risk group. High-risk patients may need more frequent monitoring because high-risk MGUS carries a higher risk for progression to multiple myeloma. High-risk MGUS is defined by the presence of M-spike > 1.5g/dl, non-IgG subtype of the paraprotein, and abnormal free light chain ratio.

Smoldering multiple myeloma

Smoldering multiple myeloma carries a 10% annual risk (on average) for progression to active multiple myeloma and therefore requires monitoring. Given the risk of progression, patients should be screened via monitoring of complete blood count (CBC), serum protein electrophoresis (SPEP), and free light chain ratio typically once yearly or more frequently. The frequency of screening may vary depending on the smoldering multiple myeloma risk group. High-risk smoldering multiple myeloma patients may need more frequent monitoring since this carries a higher risk for progression to active multiple myeloma.

Multiple myeloma

There is insufficient evidence to recommend routine screening for active multiple myeloma in the general population, but patients with MGUS or smoldering multiple myeloma should have routine laboratory checks to monitor for progression to active multiple myeloma.