Interpretive Handbook

Test 89537 :
Mayo Stratification for Myeloma and Risk-Adapted Therapy Report

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Multiple myeloma is increasingly recognized as a disease characterized by marked cytogenetic, molecular, and proliferative heterogeneity. This heterogeneity is manifested clinically by varying degrees of disease aggressiveness. Multiple myeloma patients with more aggressive disease experience suboptimal responses to some therapeutic approaches; therefore, identifying these patients is critically important for selecting appropriate treatment options.


The Mayo Stratification for Myeloma and Risk-Adapted Therapy (mSMART) algorithm classifies patients into either standard or high-risk categories based on the results of 3 assays: the plasma cell proliferation result, conventional chromosome analysis, and FISH for specific multiple myeloma-associated abnormalities.

Useful For Suggests clinical disorders or settings where the test may be helpful

Risk stratification of patients with multiple myeloma, which can assist in determining treatment and management decisions


Risk stratification of patients with newly diagnosed multiple myeloma

Interpretation Provides information to assist in interpretation of the test results

An interpretive report is provided. Patients are classified as high risk or standard risk.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

The Mayo Stratification for Myeloma and Risk-Adapted Therapy report is best used for newly diagnosed patients with multiple myeloma. It is designed for patients with multiple myeloma and may not be applicable for monoclonal gammopathy of uncertain significance, smoldering myeloma, or amyloidosis.


This stratification system is not meant to replace existing prognostic systems such as the International Staging System.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


Estimated S-phase of >1.5% associated with more aggressive disease



46,XX or 46,XY. No apparent chromosome abnormality.

An interpretative report will be provided.



An interpretative report will be provided.

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Kumar SK, Mikhael JR, Buadi FK, et al: Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines. Mayo Clin Proc 2009 Dec;84(12):1095-1110

2. Rajkumar SV, Greipp PR: Prognostic factors in multiple myeloma. Hematol Oncol Clin North Am 1999 Dec;13(6):1295-1314

3. Garcia-Sanz R, Gonzalez-Fraile MI, Mateo G, et al: Proliferative activity of plasma cells is the most relevant prognostic factor in elderly multiple myeloma patients. Int J Cancer 2004 Dec 10;112(5):884-889

4. Orfao A, Garcia-Sanz R, Lopez-Berges MC, et al: A new method for the analysis of plasma cell DNA content in multiple myeloma samples using a CD38/propidium iodide double staining technique. Cytometry 1994 Dec 1;17(4):332-339

5. Morice WG, Hanson CA, Kumar S, et al: Novel multi-parameter flow cytometry sensitively detects phenotypically distinct plasma cell subsets in plasma cell proliferative disorders. Leukemia 2007 Sep;21(9):2043-2046

6. Morice WG, Chen D, Kurtin PJ, et al: Novel immunophenotypic features of marrow lymphoplasmacytic lymphoma and correlation with Waldenstrom's macroglobulinemia. Mod Pathol 2009 Jun;22(6):807-816