From the Guidelines
A comprehensive myeloma workup should include a complete blood count, comprehensive metabolic panel, serum protein electrophoresis with immunofixation, serum free light chain assay, 24-hour urine protein electrophoresis, beta-2 microglobulin, and lactate dehydrogenase, as recommended by the NCCN Guidelines 1.
Initial Diagnostic Workup
The initial diagnostic workup for myeloma should include:
- A history and physical examination
- Baseline blood studies, such as:
- CBC with differential and platelet counts
- Blood urea nitrogen (BUN)
- Serum creatinine and serum electrolytes
- Serum calcium
- Albumin
- Lactate dehydrogenase (LDH)
- Beta-2 microglobulin
- Urine analysis, including:
- 24-hour urine for total protein
- Urine protein electrophoresis
- Urine immunofixation electrophoresis
- Serum analysis, including:
- Quantitative immunoglobulin levels (IgG, IgA, and IgM)
- Serum protein electrophoresis
- Serum immunofixation electrophoresis
- Serum free light chain (FLC) assay
Imaging Studies
Imaging studies should include:
- A skeletal survey or low-dose whole-body CT scan to detect bone lesions
- MRI or PET-CT scans if more detailed imaging is needed
Bone Marrow Studies
Bone marrow studies should include:
- Bone marrow aspiration and biopsy to detect quantitative and/or qualitative abnormalities of bone marrow plasma cells
- Chromosome analysis by metaphase cytogenetics and fluorescence in situ hybridization (FISH) to identify high-risk cytogenetic abnormalities, such as t(4;14), t(14;16), or deletion 17p 1
Prognostic Factors
Early detection of high-risk cytogenetic abnormalities is crucial, as they influence treatment approach and prognosis 1. The serum FLC assay also has prognostic value in plasma cell disorders, including monoclonal gammopathy of undetermined significance, smoldering myeloma, active myeloma, immunoglobulin light chain amyloidosis, and solitary plasmacytoma 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Myeloma Workup
- Myeloma workup typically involves serum protein electrophoresis (SPEP) to identify patients with multiple myeloma and other serum protein disorders 2.
- SPEP separates proteins based on their physical properties, and the subsets of these proteins are used in interpreting the results 2.
- A homogeneous spike-like peak in a focal region of the gamma-globulin zone indicates a monoclonal gammopathy, which is associated with a clonal process that is malignant or potentially malignant, including multiple myeloma 2.
Detection of Multiple Myeloma
- Serum protein electrophoresis can be used for detection and quantification of monoclonal gammopathy and should be recommended as a preliminary test for suspected cases of multiple myeloma 3.
- The presence of M bands and raised gamma globulin can indicate multiple myeloma, and the quantity of M protein, bone marrow biopsy, and other characteristics can help differentiate multiple myeloma from other causes of monoclonal gammopathy 3, 4.
- The relationship between serum protein electrophoresis and serum immunoglobulin profiles of patients with multiple myeloma can provide valuable information for diagnosis and detection 4.
Diagnostic Interpretation
- The presence of M bands is associated with an increase in IgG concentration and a slight increase in IgM concentration, while an elevated gamma globulin is associated with a significant increase in IgG diameter and IgG concentration 4.
- Patients with an M-band may have an increase in IgA concentration, while those with raised gamma globulin may have a decrease in IgA concentration 4.
- Serum protein electrophoresis, along with other laboratory tests, can be used in the diagnosis of multiple myeloma, especially in the early and advanced stages 4.