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Test Code MSMRT Mayo Algorithmic Approach for Stratification of Myeloma and Risk-Adapted Therapy Report

Secondary ID


Useful For

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

Reflex Tests

Test ID Reporting Name Available Separately Always Performed

Testing Algorithm

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


Based on the flow cytometric analysis and presence of greater than or equal to 0.1% monotypic plasma cells, the MPCPD / mSMART, Plasma Cell Proliferative Disorder (PCPD), FISH test will be reflexed and performed at an additional charge.

Method Name

Flow Cytometry/DNA Content/Cell Cycle Analysis

Reporting Name

mSMART Algorithmic Testing, BM

Specimen Type

Bone Marrow

Advisory Information

This test should be ordered at diagnosis of Multiple Myeloma and when the client wants MPCPD / mSMART, Plasma Cell Proliferative Disorder (PCPD), FISH to be reflexed based on the Laboratory Screening Tests for Suspected Multiple Myeloma algorithm.

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)

Acceptable: EDTA or heparin

Specimen Volume: 4 mL

Specimen Minimum Volume

3 mL

Specimen Stability Information

Specimen Type Temperature Time
Bone Marrow Ambient (preferred) 72 hours
  Refrigerated  72 hours

Reject Due To


Mild OK; Gross reject






Fully clotted or frozen specimen

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.


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

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


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

Clinical Reference

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

Day(s) and Time(s) Performed

Specimens are processed Monday through Sunday and reported Monday through Friday 8 a.m.-5 p.m.

Analytic Time

1 day (MSMRT only) 11 days (with MPCPD)

Performing Laboratory

Mayo Medical Laboratories in Rochester

Test Classification

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. 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
MSMRT mSMART Algorithmic Testing, BM In Process


Result ID Test Result Name Result LOINC Value
CK056 Monotypic Plasma Cells: In Process
CK057 Monotypic PC per Total Events In Process
CK058 Monotypic Plasma Cells S-phase In Process
CK059 Monotypic Plasma Cells DNA Index In Process
CK060 Monotypic Plasma Cells DNA Ploidy In Process
CK061 Polytypic PC per Total Events In Process
CK062 Polytypic PC per All Plasma Cells In Process
CK134 Final Diagnosis In Process


If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request Form (T726) with the specimen (