Multiple Myeloma and Monoclonal Gammopathies

C - HyperCalcemia- calcium > 11 mg/dL / >1 mg/dL the ULN

R - Renal disease - Cr >2 mg/dL or CC < 40 ml/min

A - Anemia- Hemoglobin < 10 g/dL or <2 g/dl LLN

B - Bony lesions

+1 or more:

 • Clonal bone marrow plasma cell percentage ≥60%

 • Involved: uninvolved serum free light chain ratio ≥100

 • >1 focal lesions on MRI studies

Look for gamma gap (total protein - albumin) ≥ 4 to identify hypergammaglobulinemia; SPEP determines if this is is monoclonal or polyclonal.

Causes of false- negative SPEP: 

 • Non-secretory MM (1-2% of MM), light chain deposition disease, and amyloidosis

Other causes of a monoclonal M spike: 

 • CML, B and T cell lymphoproliferative diseases, CML, amyloidosis, solitary plasmacytoma, POEMs syndrome, Castleman's, Waldenström's macroglobulinemia, and autoimmune diseases.



Dr. Ann Marie Kumfer @AnnKumfer



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