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

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
CSMRT MPCDS Pre-Analysis Cell Sorting, BM No No

Testing Algorithm

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.

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 MPCDS / mSMART, Plasma Cell Proliferative Disorder (PCPD), FISH is warranted based on the Laboratory Screening Tests for Suspected Multiple Myeloma algorithm.


This test is designed for diagnostic specimens. If follow-up testing is ordered within 12 months of a complete and informative PCPDS / Plasma Cell Proliferative Disorder, FISH, Bone Marrow result, the testing will be cancelled. If follow up testing is ordered within 12 months of an initial partial or insufficient study, the testing will proceed.

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: Lavender top (EDTA) or green top (heparin)

Specimen Volume: 4 mL

Specimen Minimum Volume

3 mL

Specimen Stability Information

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

Reject Due To

Gross hemolysis Reject
Other Fully clotted

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


Normal bone marrow

No monotypic clonal plasma cells detected



Normal polytypic plasma cells

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

Day(s) and Time(s) Performed

Specimens are processed Monday through Sunday.

Results reported Monday through Friday 8 a.m.-5 p.m.

Analytic Time

1 day with no reflex testing

Performing Laboratory

Mayo Clinic 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 93357-2


Result ID Test Result Name Result LOINC Value
CK056 Monotypic Plasma Cells: 93362-2
CK057 Monotypic PC per Total Events 93021-4
CK058 Monotypic Plasma Cells S-phase 93361-4
CK059 Monotypic Plasma Cells DNA Index 93360-6
CK060 Monotypic Plasma Cells DNA Ploidy 93359-8
CK061 Polytypic PC per Total Events 93358-0
CK062 Polytypic PC per All Plasma Cells 93020-6
CK134 Final Diagnosis 22637-3

NY State Approved



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