From the Guidelines
Initial laboratory evaluation for multiple myeloma should include a complete blood count (CBC), comprehensive metabolic panel (CMP), serum protein electrophoresis (SPEP) with immunofixation, serum free light chain assay, 24-hour urine protein electrophoresis with immunofixation, beta-2 microglobulin, and lactate dehydrogenase (LDH), as recommended by the most recent guidelines 1.
Key Components of Initial Lab Work
- Complete blood count (CBC) to assess for anemia and other cytopenias
- Comprehensive metabolic panel (CMP) to evaluate renal function, electrolytes, and calcium levels
- Serum protein electrophoresis (SPEP) with immunofixation to detect and characterize monoclonal proteins
- Serum free light chain assay to detect light chain myeloma and monitor disease activity
- 24-hour urine protein electrophoresis with immunofixation to detect and quantify urinary monoclonal proteins
- Beta-2 microglobulin and lactate dehydrogenase (LDH) for prognostic information
Additional Diagnostic Tests
- Bone marrow aspiration and biopsy to evaluate bone marrow plasma cell infiltration and detect clonal plasma cells
- Skeletal survey or advanced imaging such as whole-body low-dose CT, PET/CT, or MRI to evaluate lytic bone lesions
- Chromosome analysis by metaphase cytogenetics and fluorescence in situ hybridization (FISH) to detect chromosomal abnormalities
Importance of Recent Guidelines
The most recent guidelines from 2017 1 provide the most up-to-date recommendations for the initial laboratory evaluation of multiple myeloma, and should be followed to ensure accurate diagnosis, staging, and risk stratification to guide treatment decisions.
From the Research
Initial Lab Work for Multiple Myeloma Evaluation
The initial lab work to evaluate for multiple myeloma includes:
- Serum protein electrophoresis (SPEP) to detect and quantify monoclonal gammopathy 2
- Serum free light chain (FLC) assay to measure the ratio of involved to uninvolved FLC 3, 4
- Complete blood count (CBC) to evaluate for anemia 3, 5
- Blood chemistry tests, such as calcium and creatinine levels, to assess for hypercalcemia and renal failure 3, 5
- Urine protein electrophoresis (UPEP) to detect and quantify monoclonal gammopathy in urine 2
Additional Tests
Additional tests that may be performed to evaluate for multiple myeloma include:
- Bone marrow biopsy to assess for clonal plasma cells 3, 5
- Imaging studies, such as magnetic resonance imaging (MRI), to evaluate for lytic bone lesions 3, 5
- Cytogenetic testing to assess for high-risk genetic abnormalities, such as del(17p), t(4;14), and t(14;16) 3
- Immunofixation electrophoresis (IFE) to confirm the presence of a monoclonal protein 6
Importance of Lab Work
Lab work plays a crucial role in the diagnosis and management of multiple myeloma, as it helps to: