Multiple Myeloma Screening Guidelines

General Principles

The European Myeloma Network recommends against population-based screening for multiple myeloma outside of research protocols, due to the low absolute risk of detecting the disease in asymptomatic individuals, the absence of proven intervention strategies, and the lack of evidence demonstrating a meaningful impact on mortality or morbidity from early detection 1
The European Myeloma Network explicitly states that screening of the general population is not recommended outside of studies, based on the low absolute risk, absence of proven interventions, and lack of evidence on mortality or morbidity impact 1

For individuals with first-degree relatives who have multiple myeloma, routine screening is not recommended outside of research protocols, despite a 2-4 times higher relative risk, due to the still-low absolute risk, absence of available interventions, and unknown benefit of early detection 1

The focus should be on appropriate surveillance of diagnosed precursor conditions, such as MGUS and smoldering myeloma, rather than screening asymptomatic individuals, as recommended by the European Myeloma Network and the National Comprehensive Cancer Network 1, 2
For patients with diagnosed MGUS, follow-up should include careful history and physical examination, quantification of M-protein, complete blood count, creatinine and calcium levels, and monitoring of free light-chain ratio, as recommended by the European Myeloma Network 1

For smoldering myeloma, observation at 3-6 month intervals is the category 1 recommendation, according to the National Comprehensive Cancer Network guidelines, which stratify patients using the Mayo 2018 20/2/20 criteria 2, 3
Low-risk patients (0 factors) should be observed at 3-6 month intervals, while high-risk patients (≥2 factors) should be enrolled in a clinical trial or considered for single-agent lenalidomide, as recommended by the National Comprehensive Cancer Network 2
Surveillance testing for smoldering myeloma includes CBC, serum chemistry, quantitative immunoglobulins, serum FLC assay, 24-hour urine testing, and imaging, as recommended by the National Comprehensive Cancer Network 2

The National Comprehensive Cancer Network recommends against population-based screening outside of research protocols, and emphasizes the importance of surveillance for diagnosed precursor conditions, such as MGUS and smoldering myeloma 1, 2
The European Myeloma Network and the National Comprehensive Cancer Network agree that patients with evolving MGUS developing M-protein ≥30 g/L should be reclassified as smoldering myeloma and followed every 3-4 months 1
Rising markers or high-risk factors in smoldering myeloma require close monitoring at 3-month intervals, as recommended by the National Comprehensive Cancer Network 2