# IMWG 2014 multiple myeloma criteria

IMWG myeloma criteria

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/imwg_myeloma`
HTML: https://magentlab.com/docs/imwg-myeloma
Markdown: https://magentlab.com/docs/imwg-myeloma.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the Rajkumar 2014 International Myeloma Working Group updated criteria for multiple myeloma requiring therapy: clonal bone marrow plasma cells ≥10% or biopsy-proven plasmacytoma plus at least one myeloma-defining event (CRAB or SLiM).

## When to use

When an agent already has caller-assigned IMWG 2014 entry and myeloma-defining event flags and needs the published combination. magent does not diagnose myeloma, does not assay calcium, creatinine, hemoglobin, or free light chains, and does not read MRI.

## When not to use

- Not a medical device.
- Not a diagnosis. Criteria met is not a multiple myeloma diagnosis without the rest of the IMWG 2014 workup.
- Not smouldering multiple myeloma, MGUS, POEMS, or amyloid. This tool is myeloma requiring therapy only.
- Not Greipp ISS (myeloma-iss). Not R-ISS.
- magent does not assay calcium, creatinine, hemoglobin, or free light chains, and does not read MRI. All flags are caller-assigned.
- If marrow clonal plasma cells are <10%, more than one bone lesion is required to distinguish solitary plasmacytoma; that is the caller’s assignment of osteolytic_lesion.
- flc_ratio_ge_100 is the caller-assigned combination of involved:uninvolved serum free light-chain ratio ≥100 and involved free light chain ≥100 mg/L as published for the Freelite assay (Rajkumar 2014). magent does not assay free light chains.

## Formula

```
myeloma iff clonal_bmpc_ge_10_or_plasmacytoma and ≥1 myeloma-defining event (hypercalcemia, renal_insufficiency, anemia, osteolytic_lesion, bmpc_ge_60, flc_ratio_ge_100, or mri_gt_1_focal) (Rajkumar 2014 IMWG definition of multiple myeloma requiring therapy). Not a diagnosis. Not smouldering MM, MGUS, POEMS, or amyloid. Not Greipp ISS. Not R-ISS
```

## Citation

[International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma](https://doi.org/10.1016/S1470-2045(14)70442-5)
Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, San Miguel JF
Lancet Oncol. 2014;15(12):e538-e548
DOI: [10.1016/S1470-2045(14)70442-5](https://doi.org/10.1016/S1470-2045(14)70442-5)

## Worked example

### Entry plus CRAB hypercalcemia

Given: `anemia=false, bmpc_ge_60=false, clonal_bmpc_ge_10_or_plasmacytoma=true, flc_ratio_ge_100=false, hypercalcemia=true, mri_gt_1_focal=false, osteolytic_lesion=false, renal_insufficiency=false`

1. clonal_bmpc_ge_10_or_plasmacytoma true → entry true
2. hypercalcemia true; remaining myeloma-defining events false → any_mde true
3. myeloma true (entry plus ≥1 myeloma-defining event)


### Entry plus SLiM clonal BMPC ≥60%

Given: `anemia=false, bmpc_ge_60=true, clonal_bmpc_ge_10_or_plasmacytoma=true, flc_ratio_ge_100=false, hypercalcemia=false, mri_gt_1_focal=false, osteolytic_lesion=false, renal_insufficiency=false`

1. clonal_bmpc_ge_10_or_plasmacytoma true
2. bmpc_ge_60 true; remaining myeloma-defining events false → any_mde true
3. myeloma true


### Entry plus SLiM FLC ratio ≥100

Given: `anemia=false, bmpc_ge_60=false, clonal_bmpc_ge_10_or_plasmacytoma=true, flc_ratio_ge_100=true, hypercalcemia=false, mri_gt_1_focal=false, osteolytic_lesion=false, renal_insufficiency=false`

1. clonal_bmpc_ge_10_or_plasmacytoma true
2. flc_ratio_ge_100 true; remaining myeloma-defining events false → any_mde true
3. myeloma true


### Entry plus SLiM >1 focal MRI lesion

Given: `anemia=false, bmpc_ge_60=false, clonal_bmpc_ge_10_or_plasmacytoma=true, flc_ratio_ge_100=false, hypercalcemia=false, mri_gt_1_focal=true, osteolytic_lesion=false, renal_insufficiency=false`

1. clonal_bmpc_ge_10_or_plasmacytoma true
2. mri_gt_1_focal true; remaining myeloma-defining events false → any_mde true
3. myeloma true


### Entry without a myeloma-defining event

Given: `anemia=false, bmpc_ge_60=false, clonal_bmpc_ge_10_or_plasmacytoma=true, flc_ratio_ge_100=false, hypercalcemia=false, mri_gt_1_focal=false, osteolytic_lesion=false, renal_insufficiency=false`

1. clonal_bmpc_ge_10_or_plasmacytoma true
2. all myeloma-defining events false → any_mde false
3. myeloma false (entry without an MDE is not myeloma requiring therapy)


## Also searched as

- IMWG 2014 myeloma
- Rajkumar 2014 myeloma
- myeloma defining events
- CRAB SLiM criteria
- multiple myeloma requiring therapy
- clonal BMPC plasmacytoma
- IMWG updated myeloma criteria
- SLiM biomarkers myeloma

## Parameters

- `clonal_bmpc_ge_10_or_plasmacytoma` (boolean, required): Clonal bone marrow plasma cells ≥10% or biopsy-proven bony or extramedullary plasmacytoma, as assigned by the caller (Rajkumar 2014 IMWG entry for myeloma requiring therapy). true or false. When false, myeloma is false even if a myeloma-defining event is true. magent does not read a marrow or biopsy.
- `hypercalcemia` (boolean, required): Hypercalcemia as assigned by the caller (Rajkumar 2014 CRAB): serum calcium >0.25 mmol/L (>1 mg/dL) above the upper limit of normal or >2.75 mmol/L (>11 mg/dL). true or false. magent does not assay calcium.
- `renal_insufficiency` (boolean, required): Renal insufficiency as assigned by the caller (Rajkumar 2014 CRAB): creatinine clearance <40 mL/min or serum creatinine >177 µmol/L (>2 mg/dL). true or false. magent does not assay creatinine.
- `anemia` (boolean, required): Anemia as assigned by the caller (Rajkumar 2014 CRAB): hemoglobin value >20 g/L below the lower limit of normal or hemoglobin <100 g/L. true or false. magent does not assay hemoglobin.
- `osteolytic_lesion` (boolean, required): One or more osteolytic lesions on skeletal radiography, CT, or PET-CT, as assigned by the caller (Rajkumar 2014 CRAB). If marrow clonal plasma cells are <10%, more than one bone lesion is required to distinguish solitary plasmacytoma; that is the caller’s assignment of this flag. true or false. magent does not read imaging.
- `bmpc_ge_60` (boolean, required): Clonal bone marrow plasma cells ≥60%, as assigned by the caller (Rajkumar 2014 SLiM). true or false. magent does not read a marrow.
- `flc_ratio_ge_100` (boolean, required): Involved:uninvolved serum free light-chain ratio ≥100 and involved free light chain ≥100 mg/L, as assigned by the caller as this one flag (Rajkumar 2014 SLiM). true or false. magent does not assay free light chains.
- `mri_gt_1_focal` (boolean, required): >1 focal lesion on MRI, each ≥5 mm, as assigned by the caller (Rajkumar 2014 SLiM). true or false. magent does not read MRI.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/imwg_myeloma`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "anemia": "false",
      "bmpc_ge_60": "false",
      "clonal_bmpc_ge_10_or_plasmacytoma": "true",
      "flc_ratio_ge_100": "false",
      "hypercalcemia": "true",
      "mri_gt_1_focal": "false",
      "osteolytic_lesion": "false",
      "renal_insufficiency": "false"
    },
    {
      "anemia": "false",
      "bmpc_ge_60": "false",
      "clonal_bmpc_ge_10_or_plasmacytoma": "true",
      "flc_ratio_ge_100": "false",
      "hypercalcemia": "true",
      "mri_gt_1_focal": "false",
      "osteolytic_lesion": "false",
      "renal_insufficiency": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/imwg-myeloma

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/imwg_myeloma",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, San Miguel JF",
        "doi": "10.1016/S1470-2045(14)70442-5",
        "id": "rajkumar-2014",
        "pmid": "25439696",
        "source": "Lancet Oncol. 2014;15(12):e538-e548",
        "title": "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma"
      },
      "formula": "imwg_myeloma",
      "formula_expression": "myeloma iff clonal_bmpc_ge_10_or_plasmacytoma and ≥1 myeloma-defining event (hypercalcemia, renal_insufficiency, anemia, osteolytic_lesion, bmpc_ge_60, flc_ratio_ge_100, or mri_gt_1_focal) (Rajkumar 2014 IMWG definition of multiple myeloma requiring therapy). Not a diagnosis. Not smouldering MM, MGUS, POEMS, or amyloid. Not Greipp ISS. Not R-ISS",
      "criteria": [
        {
          "factor": "clonal_bmpc_ge_10_or_plasmacytoma",
          "met": true
        },
        {
          "factor": "hypercalcemia",
          "met": true
        },
        {
          "factor": "renal_insufficiency",
          "met": false
        },
        {
          "factor": "anemia",
          "met": false
        },
        {
          "factor": "osteolytic_lesion",
          "met": false
        },
        {
          "factor": "bmpc_ge_60",
          "met": false
        },
        {
          "factor": "flc_ratio_ge_100",
          "met": false
        },
        {
          "factor": "mri_gt_1_focal",
          "met": false
        },
        {
          "factor": "any_mde",
          "met": true
        }
      ],
      "anemia": false,
      "any_mde": true,
      "bmpc_ge_60": false,
      "clonal_bmpc_ge_10_or_plasmacytoma": true,
      "flc_ratio_ge_100": false,
      "hypercalcemia": true,
      "mri_gt_1_focal": false,
      "myeloma": true,
      "osteolytic_lesion": false,
      "renal_insufficiency": false
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, San Miguel JF",
        "doi": "10.1016/S1470-2045(14)70442-5",
        "id": "rajkumar-2014",
        "pmid": "25439696",
        "source": "Lancet Oncol. 2014;15(12):e538-e548",
        "title": "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma"
      },
      "formula": "imwg_myeloma",
      "formula_expression": "myeloma iff clonal_bmpc_ge_10_or_plasmacytoma and ≥1 myeloma-defining event (hypercalcemia, renal_insufficiency, anemia, osteolytic_lesion, bmpc_ge_60, flc_ratio_ge_100, or mri_gt_1_focal) (Rajkumar 2014 IMWG definition of multiple myeloma requiring therapy). Not a diagnosis. Not smouldering MM, MGUS, POEMS, or amyloid. Not Greipp ISS. Not R-ISS",
      "criteria": [
        {
          "factor": "clonal_bmpc_ge_10_or_plasmacytoma",
          "met": true
        },
        {
          "factor": "hypercalcemia",
          "met": true
        },
        {
          "factor": "renal_insufficiency",
          "met": false
        },
        {
          "factor": "anemia",
          "met": false
        },
        {
          "factor": "osteolytic_lesion",
          "met": false
        },
        {
          "factor": "bmpc_ge_60",
          "met": false
        },
        {
          "factor": "flc_ratio_ge_100",
          "met": false
        },
        {
          "factor": "mri_gt_1_focal",
          "met": false
        },
        {
          "factor": "any_mde",
          "met": true
        }
      ],
      "anemia": false,
      "any_mde": true,
      "bmpc_ge_60": false,
      "clonal_bmpc_ge_10_or_plasmacytoma": true,
      "flc_ratio_ge_100": false,
      "hypercalcemia": true,
      "mri_gt_1_focal": false,
      "myeloma": true,
      "osteolytic_lesion": false,
      "renal_insufficiency": false
    }
  ]
}
```

## Response fields

- `formula` (string): imwg_myeloma
- `formula_expression` (string): Rajkumar 2014 IMWG myeloma requiring therapy: entry plus ≥1 MDE
- `myeloma` (boolean): true iff clonal_bmpc_ge_10_or_plasmacytoma and at least one myeloma-defining event. Not a diagnosis. Not smouldering MM, MGUS, POEMS, or amyloid. Not Greipp ISS. Not R-ISS.
- `clonal_bmpc_ge_10_or_plasmacytoma` (boolean): Caller-assigned IMWG 2014 entry flag used
- `hypercalcemia` (boolean): Caller-assigned CRAB hypercalcemia flag used
- `renal_insufficiency` (boolean): Caller-assigned CRAB renal insufficiency flag used
- `anemia` (boolean): Caller-assigned CRAB anemia flag used
- `osteolytic_lesion` (boolean): Caller-assigned CRAB osteolytic lesion flag used
- `bmpc_ge_60` (boolean): Caller-assigned SLiM clonal BMPC ≥60% flag used
- `flc_ratio_ge_100` (boolean): Caller-assigned SLiM involved:uninvolved FLC ratio ≥100 with involved FLC ≥100 mg/L flag used
- `mri_gt_1_focal` (boolean): Caller-assigned SLiM >1 focal MRI lesion ≥5 mm flag used
- `any_mde` (boolean): true iff at least one myeloma-defining event flag is true
- `criteria` (array): Per-factor rows with factor and met for the entry flag, each myeloma-defining event, and any_mde
- `citation` (object): Rajkumar 2014 Lancet Oncol IMWG citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, San Miguel JF",
    "doi": "10.1016/S1470-2045(14)70442-5",
    "id": "rajkumar-2014",
    "pmid": "25439696",
    "source": "Lancet Oncol. 2014;15(12):e538-e548",
    "title": "International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma"
  },
  "formula": "imwg_myeloma",
  "formula_expression": "myeloma iff clonal_bmpc_ge_10_or_plasmacytoma and ≥1 myeloma-defining event (hypercalcemia, renal_insufficiency, anemia, osteolytic_lesion, bmpc_ge_60, flc_ratio_ge_100, or mri_gt_1_focal) (Rajkumar 2014 IMWG definition of multiple myeloma requiring therapy). Not a diagnosis. Not smouldering MM, MGUS, POEMS, or amyloid. Not Greipp ISS. Not R-ISS",
  "criteria": [
    {
      "factor": "clonal_bmpc_ge_10_or_plasmacytoma",
      "met": true
    },
    {
      "factor": "hypercalcemia",
      "met": true
    },
    {
      "factor": "renal_insufficiency",
      "met": false
    },
    {
      "factor": "anemia",
      "met": false
    },
    {
      "factor": "osteolytic_lesion",
      "met": false
    },
    {
      "factor": "bmpc_ge_60",
      "met": false
    },
    {
      "factor": "flc_ratio_ge_100",
      "met": false
    },
    {
      "factor": "mri_gt_1_focal",
      "met": false
    },
    {
      "factor": "any_mde",
      "met": true
    }
  ],
  "anemia": false,
  "any_mde": true,
  "bmpc_ge_60": false,
  "clonal_bmpc_ge_10_or_plasmacytoma": true,
  "flc_ratio_ge_100": false,
  "hypercalcemia": true,
  "mri_gt_1_focal": false,
  "myeloma": true,
  "osteolytic_lesion": false,
  "renal_insufficiency": false
}
```

## Errors

- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Myeloma ISS](https://magentlab.com/docs/myeloma-iss) — Apply the Greipp 2005 International Staging System for multiple myeloma from serum beta-2 microglobulin and albumin.
- [R-ISS](https://magentlab.com/docs/r-iss) — Apply the Palumbo 2015 Revised International Staging System for multiple myeloma from ISS (beta-2 microglobulin and albumin), caller-assigned high-risk cytogenetic abnormalities, and LDH above the upper limit of normal.
- [WHO 2016 SM criteria](https://magentlab.com/docs/who-sm) — Apply the Valent 2016 / WHO 2016 systemic mastocytosis diagnostic criteria (Table 1) and return whether the published combination of the major criterion plus at least one minor, or at least three minors, is met. Tryptase >20 ng/mL does not count when an unrelated myeloid neoplasm is present.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.