Fernandez de Larrea et al reported criteria for the diagnosis and management of plasma cell leukemia (PCL). One lists the criteria for progression of disease. The authors are from the International Myeloma Working Group (IMWG).


Patient selection: plasma cell leukemia


Criteria for progression – one or more of the following:

(1) increase in bone marrow plasma cells – one of the following:

(1a) > 25% increase in plasma cells in a bone marrow aspirate

(1b) >= 10% absolute increase in plasma cells

(2) > 5% absolute increase in plasma cells in peripheral blood

(3) > 25% increase in serum monoclonal protein AND absolute increase >= 0.5 g/dL (5 g/L)

(4) > 25% increase in 24 hour urinary light chain excretion AND absolute increase >= 200 mg in 24 hours

(5) progression of extramedullary disease

(5a) hypercalcemia secondary to plasma cell dyscrasia

(5b) increase in lytic bone lesions

(5c) increase in size and number of extramedullary lesions



• In a bone marrow aspirate 500 cells are typically counted.

• In a peripheral smear 200 cells are typically counted.


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