From the Guidelines
Multiple myeloma screening is not routinely recommended for the general population. Currently, there are no established screening programs for multiple myeloma in asymptomatic individuals without risk factors 1. Screening is typically only considered for people with a strong family history of multiple myeloma or related blood disorders, or those with known genetic predispositions.
Key Considerations
When screening is performed, it usually involves:
- Blood tests including complete blood count, serum protein electrophoresis, serum free light chain assay
- Sometimes urine tests to detect abnormal proteins (Bence Jones proteins) 1. These tests can identify monoclonal gammopathy of undetermined significance (MGUS), a precursor condition to multiple myeloma.
Monitoring and Diagnosis
For individuals with MGUS or other risk factors, regular monitoring every 6-12 months may be recommended to watch for progression to active multiple myeloma. The lack of widespread screening is due to the relatively low prevalence of multiple myeloma in the general population and the absence of evidence that early detection in asymptomatic individuals improves outcomes 1. Instead, diagnosis typically occurs when symptoms develop, such as bone pain, fatigue, recurrent infections, or kidney problems.
Diagnostic Criteria
The definition of multiple myeloma includes smoldering (asymptomatic) myeloma and active (symptomatic) myeloma, with specific criteria for each, including serum monoclonal protein levels, Bence-Jones protein levels, and clonal bone marrow plasma cells 1.
From the Research
Multiple Myeloma Screening
- Multiple myeloma is a hematological malignancy that develops over years from asymptomatic precursors, such as monoclonal gammopathy of undetermined significance and smoldering multiple myeloma 2.
- Recent evidence shows that initiating treatment at an asymptomatic stage can significantly improve outcomes in multiple myeloma 2.
- The precursors of multiple myeloma are easily detected by serum protein electrophoresis and free light chain assay of the serum, raising the question of whether population-based screening could detect multiple myeloma at an asymptomatic stage 2.
Diagnostic Tests
- Evaluation of patients with possible multiple myeloma includes measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels; serum protein electrophoresis with immunofixation; 24-hour urine protein electrophoresis; and full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging 3.
- Accurate diagnosis is generally based on several factors, including physical evaluation, patient history, symptoms, and diagnostic testing results 4.
- The standards for initial diagnostic tests are determined by blood and urine tests as well as a bone marrow biopsy and skeletal imaging, such as X-rays, CT scans, and MRI scans 4.
Screening Criteria
- Screening is a hallmark of care in many malignancies, and there are accepted criteria for when screening is appropriate 2.
- However, there are ongoing studies that may fill critical gaps in the literature, but their results are still pending 2.
- A defined target population for screening is lacking, and there is a need for data on the benefits and harms of screening 2.
Current State of Evidence
- Current studies show promising results in the treatment of multiple myeloma, due to new agents such as immunomodulatory drugs, proteasome inhibitors, and antibodies, which may improve prognosis and survival rate among myeloma patients in the future 4.
- However, treatment algorithms have become more complex and expensive 4.
- Emerging evidence supports the need for refined definitions and more targeted strategies to improve high-risk multiple myeloma management 5.