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The new 2/20/20 clinical risk stratification model incorporates 3 factors (serum M-protein 2 g/dL, involved to uninvolved FLC ratio 20, and BMPC infiltration 20%) to stratify patients with SMM diagnosed ing to the IMWG 2014 criteria into low-risk, intermediate-risk, and high-risk groups (0 factors, 1 factor,
Irrespective of the methodologic approach, multiple cause analysis complements the single underlying cause approach, uses useful information that is usually ignored, and offers an additional perspective of the causes that contribute to death.
A bone marrow biopsy is usually needed to confirm multiple myeloma. A needle is used to take a small sample of bone marrow (where all the blood cells are made) from one of your bones, usually the pelvis. A small sample of bone may also be removed.
The diagnosis of MM requires 10% or more clonal plasma cells on bone marrow examination or a biopsy-proven plasmacytoma plus the presence of one or more myeloma-defining events. 10 Myeloma-defining events in- clude the presence of one or more CRAB features, or one or more biomarkers of malignancy.
Original CRAB Criteria for the Diagnosis of Multiple Myeloma Hypercalcemia: serum calcium 0.25 mmol/L (1mg/dL) higher than the upper limit of normal or 2.75 mmol/L (11mg/dL) Renal insufficiency: creatinine clearance 177 micro mol/L (2mg/dL)
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Risk stratification: The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation is considered high-risk multiple myeloma. Presence of any two high risk factors is considered double-hit myeloma; three or more high risk factors is triple-hit myeloma.
Diagnosis: The diagnosis requires 10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE) namely CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal

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