From the Guidelines
Multiple myeloma diagnosis should be based on a combination of tests including blood tests, urine tests, bone marrow biopsy, imaging studies, and genetic testing, with a focus on detecting monoclonal protein (M-protein) components in serum and urine, as well as evaluating bone marrow plasma cell infiltration and lytic bone lesions, as recommended by the most recent guidelines 1.
Diagnostic Tests
The diagnostic workup for multiple myeloma should include:
- Blood tests: complete blood count, blood chemistry, serum protein electrophoresis (SPEP), and serum immunofixation electrophoresis (SIFE) to detect and evaluate M-protein components in serum 1
- Urine tests: 24-hour urine collection for total protein, urine protein electrophoresis (UPEP), and urine immunofixation electrophoresis (UIFE) to detect Bence Jones proteins 1
- Bone marrow biopsy: to evaluate bone marrow plasma cell infiltration and detect quantitative and/or qualitative abnormalities of bone marrow plasma cells 1
- Imaging studies: X-rays, MRI, CT, and PET scans to evaluate lytic bone lesions and detect any bone damage 1
- Genetic testing: to identify chromosomal abnormalities and detect high-risk cytogenetics, which can impact prognosis and treatment decisions 1
Treatment Options
Treatment options for multiple myeloma depend on disease stage and patient factors, and may include:
- Induction therapy with combinations like VRd (bortezomib, lenalidomide, dexamethasone) or KRd (carfilzomib, lenalidomide, dexamethasone) for 3-4 cycles 1
- Autologous stem cell transplantation followed by maintenance therapy, typically with lenalidomide 10-15mg daily, for eligible patients 1
- Regimens like Rd (lenalidomide, dexamethasone) or VMP (bortezomib, melphalan, prednisone) for transplant-ineligible patients 1
- Different drug combinations, including daratumumab, pomalidomide, or isatuximab-based regimens, for relapsed disease 1
- Supportive care, including bisphosphonates (zoledronic acid 4mg IV monthly) to prevent bone complications, pain management, and prevention of infections 1
Key Considerations
Treatment decisions should be individualized based on patient age, comorbidities, cytogenetic risk factors, and previous therapies, as multiple myeloma remains incurable but increasingly manageable with modern therapies that target plasma cell biology 1. The use of serum free light chain (FLC) assay, along with SPEP and SIFE, yields high sensitivity while screening for MM and related plasma cell disorders, and has prognostic value in plasma cell disorders 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Tests for Multiple Myeloma
- Serum protein electrophoresis (SPE) is a standard tool for multiple myeloma routine diagnostics, used to detect and quantify M-protein 2, 3, 4, 5.
- Immunofixation electrophoresis (IFE) is used to characterize M-protein and confirm the diagnosis of multiple myeloma 2, 3, 4.
- Free light chain (FLC) assay is used to monitor patients with multiple myeloma, especially those with light chain multiple myeloma 3, 6.
- Mass spectrometry (MS) can be used to detect and quantify M-protein with higher sensitivity than SPE/IFE 2, 6.
- Heavy-chain variable region clonotypic peptides and LC-MS/MS can be used to monitor M-proteins in patients with multiple myeloma 6.
Treatment Options for Multiple Myeloma
- Autologous stem cell transplantation (ASCT) is a treatment option for multiple myeloma, which can lead to a reduction in M-protein levels 3.
- Cytotoxic chemotherapy, such as VAD or VELCADE, can be used to treat multiple myeloma before ASCT 3.
- Monitoring of M-protein levels using SPE, IFE, and FLC assay can help assess the effectiveness of treatment and detect relapse 3, 6.
Limitations and Future Directions
- Current diagnostic methods, such as SPE and IFE, may have limitations in terms of sensitivity and specificity 2, 6.
- New methods, such as MS and LC-MS/MS, may offer improved sensitivity and specificity for detecting and monitoring M-proteins 2, 6.
- Further research is needed to fully understand the role of these new methods in the diagnosis and treatment of multiple myeloma 2, 6.