From the Guidelines
The initial diagnostic workup for multiple myeloma should include a complete blood count (CBC), comprehensive metabolic panel, serum protein electrophoresis (SPEP) with immunofixation, serum free light chain assay, 24-hour urine protein electrophoresis, beta-2 microglobulin, and lactate dehydrogenase (LDH) as recommended by the most recent guidelines 1.
Initial Diagnostic Workup
The following tests are essential for diagnosing and monitoring multiple myeloma:
- Complete blood count (CBC) to assess for anemia, thrombocytopenia, or leukopenia
- Comprehensive metabolic panel to evaluate kidney function, calcium levels, and liver function
- Serum protein electrophoresis (SPEP) with immunofixation to identify and quantify monoclonal proteins
- Serum free light chain assay to measure kappa and lambda light chains and their ratio
- 24-hour urine protein electrophoresis to detect Bence Jones proteins
- Beta-2 microglobulin and lactate dehydrogenase (LDH) for prognostic assessment
Bone Marrow and Imaging Studies
Bone marrow aspiration and biopsy are crucial to confirm plasma cell infiltration, with flow cytometry and cytogenetic studies providing important prognostic information 1. Imaging studies like skeletal survey, MRI, CT, or PET-CT are needed to assess bone involvement.
Ongoing Management
For ongoing management, regular monitoring should include CBC, renal function tests, calcium levels, SPEP with immunofixation, and serum free light chain assays to evaluate treatment response and disease progression 1. These tests help clinicians diagnose multiple myeloma according to established criteria, stratify risk, guide treatment decisions, and monitor response to therapy over time.
Key Considerations
It is essential to use the same test for serial studies to ensure accurate relative quantification of the myeloma or M-protein 1. The serum free light chain assay is useful to monitor disease response and progression in a proportion of patients with non-secretory myeloma.
From the Research
Labs for Multiple Myeloma Diagnosis
- Hemoglobin measurement to assess anemia 2
- Serum creatinine to evaluate kidney function 2
- Serum calcium to check for hypercalcemia 2
- Serum free light chain levels to detect abnormal protein production 2
- Serum protein electrophoresis with immunofixation to identify monoclonal gammopathy 2, 3, 4
- 24-hour urine protein electrophoresis to detect abnormal protein in the urine 2
Additional Diagnostic Tests
- Full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging to evaluate bone lesions 2
- Fluorescence in situ hybridization to assess malignant plasma cell genomic features 2
- Lactate dehydrogenase measurement to evaluate tumor burden 2
- β2 microglobulin and albumin measurement to assess disease biology and prognosis 2
Staging and Prognosis
- Revised International Staging System to combine data from serum biomarkers and malignant plasma cell genomic features to assess estimated progression-free survival and overall survival 2
- Evaluation of serum protein electrophoresis and immunoglobulin profiles to determine the relationship between SPE and serum immunoglobulin profiles of patients with multiple myeloma 4
Management and Treatment
- Induction therapy with a combination of an injectable proteasome inhibitor, an oral immunomodulatory agent, and dexamethasone 2, 5
- Autologous hematopoietic stem cell transplantation followed by maintenance lenalidomide for eligible patients 2
- Consideration of new drugs such as carfilzomib, pomalidomide, panobinostat, ixazomib, elotuzumab, and daratumumab 5
- Systemic therapy for patients with newly diagnosed as well as previously treated multiple myeloma 6