Test Catalog

Test ID: MSMRT    
Mayo Algorithmic Approach for Stratification of Myeloma and Risk-Adapted Therapy Report, Bone Marrow

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

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Based on the flow cytometric analysis and presence of greater than or equal to 0.1% monotypic plasma cells, the pre-analysis cell sorting and FISH for plasma cell proliferative disorder will be reflexed and performed at an additional charge.


This test is designed for diagnostic specimens. If a request for testing has been submitted within 12 months of a complete and informative plasma cell proliferative disorder FISH study, the current test request will be cancelled.


See Laboratory Screening Tests for Suspected Multiple Myeloma in Special Instructions.

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.


Mayo Algorithmic Approach for Stratification of Myeloma and Risk-Adapted Therapy (MSMRT) classifies patients into either standard or high-risk categories based on the results of 2 assays: plasma cell proliferation and FISH for specific multiple myeloma-associated abnormalities.

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.


Normal bone marrow

No monotypic clonal plasma cells detected



Normal polytypic plasma cells

DNA index (G0/G1 cells): Diploid 0.95-1.05

Interpretation Provides information to assist in interpretation of the test results

An interpretive report will be 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

Mayo Algorithmic Approach for Stratification of Myeloma and Risk-Adapted Therapy (MSMRT) 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.

Clinical Reference Recommendations for in-depth reading of a clinical nature

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

2. 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

3. 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

4. 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

5. Gonsalves WI, Buadi FK, Ailawadhi S, et al. Utilization of hematopoietic stem cell transplantation for the treatment of multiple myeloma: a Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus statement. Bone Marrow Transplant. 2019;54(3):353–367. doi:10.1038/s41409-018-0264-8

6. Kapoor P, Ansell SM, Fonseca R, et al. Diagnosis and Management of Waldenstrom Macroglobulinemia: Mayo Stratification of Macroglobulinemia and Risk-Adapted Therapy (mSMART) Guidelines 2016. JAMA Oncol. 2017 Sep 1;3(9):1257–1265. doi:10.1001/jamaoncol.2016.5763

7. Mikhael JR, Dingli D, Roy V, et al. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013 [published correction appears in Mayo Clin Proc. 2013 Jul;88(7):777. Stewart, Keith [corrected to Stewart, A Keith]]. Mayo Clin Proc. 2013;88(4):360–376. doi:10.1016/j.mayocp.2013.01.019

8. Swerdlow S, Campo E, Harris NL, et al: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press: Lyon. 2017

9. Kumar SK, Rajkumar SV: The multiple myelomas-current concepts in cytogenetic classification and therapy. Nat Rev Clin Oncol 2018;15(7):409-421 doi:10.1038/s41571-018-0018-y

10. Rajkumar SV, Landgren O, Mateos MV: Smoldering multiple myeloma. Blood 2015 May 14;125(20):3069-3075 doi:10.1182/blood-2014-09-568899

Special Instructions Library of PDFs including pertinent information and forms related to the test