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HelpTest Code MSMRD Myeloma Stratification and Risk-Adapted Therapy with Reflex to Minimal Residual Disease, Bone Marrow
Ordering Guidance
Necessary Information
1. Include patient's disease state (untreated, treated, monoclonal gammopathy of undetermined significance, stable).
2. Indicate if patient is on anti-CD38 therapy.
Specimen Required
Specimen Type: Redirected bone marrow
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA)
Specimen Volume: 4 mL
Useful For
Risk stratification of patients with treated multiple myeloma, which can assist in determining treatment and management decisions
Risk stratification of patients with newly diagnosed multiple myeloma
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CSMRT | MPCDS Pre-Analysis Cell Sorting, BM | No | No |
| MPCDS | mSMART Eval, PCPDs, FISH | Yes, (Order PCPDS) | No |
| MRDMR | Multiple Myeloma MRD by Flow, BM | Yes, (Order MRDMM) | No |
Testing Algorithm
Based on the flow cytometric analysis and the presence of greater than or equal to 0.1% monotypic plasma cells, pre-analysis cell sorting and fluorescence in situ hybridization for plasma cell proliferative disorders will be performed at an additional charge.
Based on the flow cytometric analysis and the absence of monotypic plasma cells, then minimal residual disease for multiple myeloma will be performed at an additional charge.
Method Name
Flow Cytometry/DNA Content/Cell Cycle Analysis
Reporting Name
mSMART with Reflex to MRD, BMSpecimen Type
Bone MarrowSpecimen Minimum Volume
3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Bone Marrow | Ambient (preferred) | 72 hours | |
| Refrigerated | 72 hours |
Reject Due To
| Gross hemolysis | Reject |
| Fully clotted | Reject |
Clinical Information
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 algorithmic approach for stratification of myeloma and risk-adapted therapy classifies patients into either standard or high-risk categories based on the results of 2 assays: plasma cell proliferation and fluorescence in situ hybridization for specific multiple myeloma-associated abnormalities.
Reference Values
PLASMA CELL CLONALITY:
Normal bone marrow
No monotypic clonal plasma cells detected
DNA INDEX:
Normal polytypic plasma cells
DNA index (G0/G1 cells): Diploid 0.95-1.05
Interpretation
The interpretation of results includes an overview of the results and the associated diagnostic, prognostic, and therapeutic implications.
Cautions
This test report is best used for patients treated for multiple myeloma to confirm remission has been achieved or as an annual follow-up of those in remission or in uncertain remission. 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.
Day(s) Performed
Preanaltyical processing: Monday through Saturday
Results reported: Monday through Friday
Report Available
1 to 13 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
88182-Flow cytometry, cell cycle or DNA analysis
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185 x 5-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
88187-Flow cytometry interpretation, 2 to 8 Markers
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MSMRD | mSMART with Reflex to MRD, BM | 93363-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CK056 | Monotypic Plasma Cells: | 93362-2 |
| CK057 | Monotypic PC per Total Events | 93021-4 |
| CK058 | Monotypic Plasma Cells S-phase | 93361-4 |
| CK059 | Monotypic Plasma Cells DNA Index | 93360-6 |
| CK060 | Monotypic Plasma Cells DNA Ploidy | 93359-8 |
| CK061 | Polytypic PC per Total Events | 93358-0 |
| CK062 | Polytypic PC per All Plasma Cells | 93020-6 |
| 616032 | Final Diagnosis | 22637-3 |