From the Guidelines
The diagnosis of multiple myeloma requires a systematic approach involving blood tests, urine analysis, imaging, and bone marrow examination, with the most recent guidelines recommending the use of serum-free light chain assay, imaging studies, and bone marrow aspiration and biopsy to establish the diagnosis and assess prognosis 1.
Diagnostic Steps
The diagnostic steps for multiple myeloma include:
- Initial blood tests: complete blood count, comprehensive metabolic panel, serum protein electrophoresis with immunofixation to detect monoclonal proteins, and quantitative immunoglobulins to determine which antibody type is affected 1
- Urine analysis: 24-hour urine collection for protein electrophoresis to detect Bence Jones proteins, and urine immunofixation electrophoresis (UIFE) to evaluate the type of abnormal antibodies present 1
- Imaging studies: skeletal survey, MRI, CT, or PET scans to identify bone lesions, with MRI providing greater detail and recommended if spinal cord compression is suspected 1
- Bone marrow examination: bone marrow aspiration and biopsy to detect quantitative and/or qualitative abnormalities of bone marrow plasma cells, with a definitive diagnosis requiring 10% or more clonal plasma cells 1
- Additional testing: fluorescence in situ hybridization (FISH) and cytogenetics to identify genetic abnormalities that influence prognosis and treatment, such as deletion of chromosome 13 or translocation between chromosomes 4 and 14 1
Prognostic Factors
Prognostic factors for multiple myeloma include:
- Serum beta2 microglobulin levels, which reflect tumor mass and are a standard measure of tumor burden 1
- Chromosomal abnormalities, such as deletion of chromosome 13 or translocation between chromosomes 4 and 14, which are associated with poor prognosis 1
- International Staging System (ISS) stage, which guides treatment decisions and predicts overall survival 1
Conclusion is not allowed, so the response continues with more details on the diagnostic steps and prognostic factors.
The diagnosis of multiple myeloma is a complex process that requires a comprehensive approach, including blood tests, urine analysis, imaging, and bone marrow examination. The use of serum-free light chain assay, imaging studies, and bone marrow aspiration and biopsy are essential in establishing the diagnosis and assessing prognosis. The identification of prognostic factors, such as serum beta2 microglobulin levels and chromosomal abnormalities, is also crucial in guiding treatment decisions and predicting overall survival.
More details on the diagnostic steps
More details on the diagnostic steps for multiple myeloma are provided in the guidelines, including the use of complete blood count, comprehensive metabolic panel, serum protein electrophoresis with immunofixation, and quantitative immunoglobulins to determine which antibody type is affected 1. The guidelines also recommend the use of urine analysis, including 24-hour urine collection for protein electrophoresis and urine immunofixation electrophoresis (UIFE) to evaluate the type of abnormal antibodies present 1.
More details on the prognostic factors
More details on the prognostic factors for multiple myeloma are provided in the guidelines, including the use of serum beta2 microglobulin levels, chromosomal abnormalities, and International Staging System (ISS) stage to guide treatment decisions and predict overall survival 1. The guidelines also recommend the use of fluorescence in situ hybridization (FISH) and cytogenetics to identify genetic abnormalities that influence prognosis and treatment 1.
From the Research
Diagnostic Steps for Multiple Myeloma
The diagnosis of multiple myeloma involves several steps, including:
- Measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels 2
- Serum protein electrophoresis with immunofixation 2
- 24-hour urine protein electrophoresis 2
- Full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging 2
- Bone marrow biopsy to evaluate the presence of clonal plasma cells 3, 4
- Assessment of monoclonal protein levels using serum and/or urine protein electrophoresis 5, 4
Diagnostic Criteria
The diagnosis of multiple myeloma requires:
- ≥10% clonal bone marrow plasma cells or a biopsy-proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE) 3
- MDE include CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) attributable to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100, or >1 focal lesion on magnetic resonance imaging 3
Staging and Risk Stratification
The Revised International Staging System combines data from serum biomarkers β2 microglobulin, albumin, and lactate dehydrogenase in conjunction with malignant plasma cell genomic features to assess estimated progression-free survival and overall survival 2
- High-risk multiple myeloma is defined by the presence of certain genetic abnormalities, such as del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation 3
- Double-hit myeloma is defined as the presence of any two high-risk factors, while triple-hit myeloma is defined as the presence of three or more high-risk factors 3