# IMWG updated criteria for the diagnosis of multiple myeloma (2014)

Source: https://onco.cc/key-papers/paper-imwg-criteria-rajkumar-lancet-oncol-2014/  
OnCo record `paper-imwg-criteria-rajkumar-lancet-oncol-2014` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2014 International Myeloma Working Group criteria allow myeloma to be diagnosed and treated before organ damage occurs when biomarkers such as 60 percent marrow plasma cells or a very high light-chain ratio predict imminent progression.

## Summary

Updated diagnostic criteria adding three myeloma-defining biomarkers (clonal marrow plasma cells 60 percent or more, involved to uninvolved free light chain ratio 100 or more, more than one focal lesion on MRI) to the classic CRAB features, and revising the definitions of smouldering myeloma and related plasma cell disorders.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet Oncology
- Year: 2014
- DOI: 10.1016/S1470-2045(14)70442-5
- Authors: Rajkumar SV, Dimopoulos MA, Palumbo A, et al.
- What it means: Whether a patient is labelled smouldering or active myeloma, and therefore whether treatment starts, depends on these criteria.
- Caveats: Biomarker thresholds were based on retrospective cohorts and continue to be refined.

## Sources

- Lancet Oncol 2014: https://doi.org/10.1016/S1470-2045(14)70442-5
- PubMed: https://pubmed.ncbi.nlm.nih.gov/25439696/

## Connected records

- cancers: [Plasma cell leukaemia](https://onco.cc/cancers/plasma-cell-leukaemia/), [Smouldering multiple myeloma](https://onco.cc/cancers/smouldering-myeloma/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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