# SMM 2/20/20 risk (Lakshman 2018) SMM 2/20/20 Status: LIVE Price: $0.005 USDC `GET /api/calc/smm_22020` HTML: https://magentlab.com/docs/smm-22020 Markdown: https://magentlab.com/docs/smm-22020.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Count Lakshman 2018 2/20/20 smoldering-myeloma risk factors (BMPC >20%, M-protein >2 g/dL, involved/uninvolved FLC ratio >20) and return low, intermediate, or high with published median TTP. ## When to use When an agent has caller-supplied bone-marrow plasma-cell percent, serum M-protein, and involved/uninvolved FLC ratio for smoldering myeloma and needs the published Lakshman 2018 2/20/20 factor count, not Mayo 70/20, not PETHEMA, not myeloma ISS, and not a treatment order. ## When not to use - Not a medical device. magent does not examine the patient and does not assay marrow, M-protein, or free light chains. - Not a myeloma diagnosis or treatment order. This is Lakshman 2018 2/20/20 SMM risk only, not Mayo 70/20, not PETHEMA, not Greipp ISS, and not R-ISS. - IMWG 2014 myeloma-defining SLiM criteria stay outside this score: BMPC 60% or above and involved/uninvolved FLC ratio 100 or above are rejected, not scored. MRI focal lesions are not an input. - The three 2/20/20 cutoffs are strict greater-than (BMPC >20, M-protein >2 g/dL, FLC ratio >20). Values equal to 20, 2, and 20 do not add a factor. ## Formula ``` Lakshman 2018 2/20/20 = (bmpc_percent > 20) + (m_protein_g_dl > 2) + (flc_ratio > 20); each 1; max 3; 0 low median TTP 110 months, 1 intermediate 68 months, 2 or 3 high 29 months. Not Mayo 70/20. Not PETHEMA. Not myeloma ISS ``` ## Citation [Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria](https://doi.org/10.1038/s41408-018-0077-4) Lakshman A, Rajkumar SV, Buadi FK, et al. Blood Cancer J. 2018;8(6):59 DOI: [10.1038/s41408-018-0077-4](https://doi.org/10.1038/s41408-018-0077-4) ## Worked example ### BMPC 25%, M-protein 2.5 g/dL, FLC ratio 25 Given: `bmpc_percent=25, flc_ratio=25, m_protein_g_dl=2.5` 1. bmpc_percent 25 > 20 → 1; m_protein_g_dl 2.5 > 2 → 1; flc_ratio 25 > 20 → 1 2. factor_count = 3 (max 3); risk_group = high; median_ttp_months = 29 ### BMPC 15%, M-protein 1.5 g/dL, FLC ratio 10 Given: `bmpc_percent=15, flc_ratio=10, m_protein_g_dl=1.5` 1. bmpc_percent 15 is not > 20 → 0; m_protein_g_dl 1.5 is not > 2 → 0; flc_ratio 10 is not > 20 → 0 2. factor_count = 0; risk_group = low; median_ttp_months = 110 ## Also searched as - smoldering multiple myeloma - SMM 2/20/20 - Lakshman 2018 SMM - 20/2/20 SMM - smouldering myeloma risk - SMM time to progression - BMPC M-protein FLC SMM - Lakshman smoldering myeloma ## Parameters - `bmpc_percent` (number, required): Bone-marrow plasma cells as a percent (10-59). >20 scores 1 (Lakshman 2018 2/20/20). 20 scores 0. 10 is the SMM floor. 60 or above is IMWG 2014 myeloma and is rejected, not scored. magent does not read a marrow. - `m_protein_g_dl` (number, required): Serum M-protein in g/dL (0-15). >2 scores 1 (Lakshman 2018 2/20/20). 2 scores 0. magent does not assay M-protein. - `flc_ratio` (number, required): Involved/uninvolved serum free light-chain ratio as assigned by the caller (0.01-99.9). >20 scores 1 (Lakshman 2018 2/20/20). 20 scores 0. 100 or above is IMWG 2014 myeloma and is rejected, not scored. magent does not assay free light chains. ## 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/smm_22020` 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": [ { "bmpc_percent": "25", "flc_ratio": "25", "m_protein_g_dl": "2.5" }, { "bmpc_percent": "25", "flc_ratio": "25", "m_protein_g_dl": "2.5" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/smm-22020 Example 200: ```json { "count": 2, "path": "/api/calc/smm_22020", "items": [ { "components": [ { "value": 25.0, "factor": "bmpc_percent_gt_20", "points": 1, "present": true }, { "value": 2.5, "factor": "m_protein_gt_2", "points": 1, "present": true }, { "value": 25.0, "factor": "flc_ratio_gt_20", "points": 1, "present": true } ], "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": "Lakshman A, Rajkumar SV, Buadi FK, et al.", "doi": "10.1038/s41408-018-0077-4", "id": "lakshman-2018", "pmid": "29895887", "source": "Blood Cancer J. 2018;8(6):59", "title": "Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria" }, "formula": "smm_22020", "formula_expression": "Lakshman 2018 2/20/20 = (bmpc_percent > 20) + (m_protein_g_dl > 2) + (flc_ratio > 20); each 1; max 3; 0 low median TTP 110 months, 1 intermediate 68 months, 2 or 3 high 29 months. Not Mayo 70/20. Not PETHEMA. Not myeloma ISS", "max_score": 3, "score": 3, "risk_group": "high", "bmpc_percent": 25.0, "factor_count": 3, "flc_ratio": 25.0, "m_protein_g_dl": 2.5, "median_ttp_months": 29 }, { "components": [ { "value": 25.0, "factor": "bmpc_percent_gt_20", "points": 1, "present": true }, { "value": 2.5, "factor": "m_protein_gt_2", "points": 1, "present": true }, { "value": 25.0, "factor": "flc_ratio_gt_20", "points": 1, "present": true } ], "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": "Lakshman A, Rajkumar SV, Buadi FK, et al.", "doi": "10.1038/s41408-018-0077-4", "id": "lakshman-2018", "pmid": "29895887", "source": "Blood Cancer J. 2018;8(6):59", "title": "Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria" }, "formula": "smm_22020", "formula_expression": "Lakshman 2018 2/20/20 = (bmpc_percent > 20) + (m_protein_g_dl > 2) + (flc_ratio > 20); each 1; max 3; 0 low median TTP 110 months, 1 intermediate 68 months, 2 or 3 high 29 months. Not Mayo 70/20. Not PETHEMA. Not myeloma ISS", "max_score": 3, "score": 3, "risk_group": "high", "bmpc_percent": 25.0, "factor_count": 3, "flc_ratio": 25.0, "m_protein_g_dl": 2.5, "median_ttp_months": 29 } ] } ``` ## Response fields - `formula` (string): smm_22020 - `formula_expression` (string): Exact expression used - `bmpc_percent` (number): Bone-marrow plasma-cell percent used for the >20 factor - `m_protein_g_dl` (number): Serum M-protein in g/dL used for the >2 factor - `flc_ratio` (number): Caller-assigned involved/uninvolved FLC ratio used for the >20 factor - `score` (integer): Factor count 0-3 (same as factor_count) - `max_score` (integer): Always 3 - `factor_count` (integer): How many of the three Lakshman 2018 factors are present (0-3) - `risk_group` (string): low when factor_count is 0, intermediate when 1, high when 2 or 3 (Lakshman 2018). Not a myeloma diagnosis. Not Mayo 70/20. Not PETHEMA. Not myeloma ISS. Not a treatment order. - `median_ttp_months` (integer): Lakshman 2018 median time to progression in months: 110 (low), 68 (intermediate), 29 (high) - `components` (array): Per-factor points - `citation` (object): Lakshman et al. Blood Cancer J. 2018 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 25.0, "factor": "bmpc_percent_gt_20", "points": 1, "present": true }, { "value": 2.5, "factor": "m_protein_gt_2", "points": 1, "present": true }, { "value": 25.0, "factor": "flc_ratio_gt_20", "points": 1, "present": true } ], "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": "Lakshman A, Rajkumar SV, Buadi FK, et al.", "doi": "10.1038/s41408-018-0077-4", "id": "lakshman-2018", "pmid": "29895887", "source": "Blood Cancer J. 2018;8(6):59", "title": "Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria" }, "formula": "smm_22020", "formula_expression": "Lakshman 2018 2/20/20 = (bmpc_percent > 20) + (m_protein_g_dl > 2) + (flc_ratio > 20); each 1; max 3; 0 low median TTP 110 months, 1 intermediate 68 months, 2 or 3 high 29 months. Not Mayo 70/20. Not PETHEMA. Not myeloma ISS", "max_score": 3, "score": 3, "risk_group": "high", "bmpc_percent": 25.0, "factor_count": 3, "flc_ratio": 25.0, "m_protein_g_dl": 2.5, "median_ttp_months": 29 } ``` ## Errors - HTTP 400 `invalid_bmpc`: bmpc_percent must be a number from 10 to 59 (Lakshman 2018 SMM bone-marrow plasma cells; ≥60 is myeloma). Returned before settlement; you are not charged. - HTTP 400 `invalid_m_protein`: m_protein_g_dl must be a number from 0 to 15 (Lakshman 2018 serum M-protein g/dL). Returned before settlement; you are not charged. - HTTP 400 `invalid_flc_ratio`: flc_ratio must be a number from 0.01 to 99.9 (Lakshman 2018 involved/uninvolved FLC ratio; ≥100 is myeloma). 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. - [IMWG myeloma criteria](https://magentlab.com/docs/imwg-myeloma) — 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). ## 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.