Diagnostic evaluation for SMM
| Exam, laboratory and imaging studies . | Studies to be performed . |
|---|---|
| Medical history and physical examination | Determine symptoms suggestive of symptomatic disease such as bone pain, weight loss, neuropathy, and rule out amyloidosis if any symptoms suggestive of AL amyloidosis |
| Blood and urine studies | Complete blood count and differential* |
| Chemistry profile including BUN, creatinine*, | |
| Total protein, LDH, calcium, phosphate | |
| β-2 microglobulin and albumin | |
| Serum protein electrophoresis, immunofixation,* | |
| Serum-free light chain analysis* | |
| Quantitative tests for IgG, IgA, and IgM | |
| 24-hour urine for UPEP and immunofixation | |
| NT-proBNP to rule out AL amyloidosis | |
| Bone marrow studies | Biopsy for histology* |
| Immunophenotype | |
| Cytogenetic analysis and fluorescence in situ hybridization focused on del(17p13), del(13q), del(1p12), ampl(1q21), t(11;14), t(4;14), and t(14;16) | |
| In the future, consider sequencing studies such as ClonoSIGHT, targeted DNA sequencing, or RNA sequencing if available | |
| Imaging | Skeletal survey* |
| Spine/pelvis MRI to rule lytic lesions* | |
| Optional PET/CT scan or low-dose CT scan to rule out lytic lesions |
| Exam, laboratory and imaging studies . | Studies to be performed . |
|---|---|
| Medical history and physical examination | Determine symptoms suggestive of symptomatic disease such as bone pain, weight loss, neuropathy, and rule out amyloidosis if any symptoms suggestive of AL amyloidosis |
| Blood and urine studies | Complete blood count and differential* |
| Chemistry profile including BUN, creatinine*, | |
| Total protein, LDH, calcium, phosphate | |
| β-2 microglobulin and albumin | |
| Serum protein electrophoresis, immunofixation,* | |
| Serum-free light chain analysis* | |
| Quantitative tests for IgG, IgA, and IgM | |
| 24-hour urine for UPEP and immunofixation | |
| NT-proBNP to rule out AL amyloidosis | |
| Bone marrow studies | Biopsy for histology* |
| Immunophenotype | |
| Cytogenetic analysis and fluorescence in situ hybridization focused on del(17p13), del(13q), del(1p12), ampl(1q21), t(11;14), t(4;14), and t(14;16) | |
| In the future, consider sequencing studies such as ClonoSIGHT, targeted DNA sequencing, or RNA sequencing if available | |
| Imaging | Skeletal survey* |
| Spine/pelvis MRI to rule lytic lesions* | |
| Optional PET/CT scan or low-dose CT scan to rule out lytic lesions |
These studies are mandatory for risk stratification of patients with SMM and exclusion of patients with overt symptomatic MM or with the new classified patients with MDE.