What is included in a multiple myeloma (plasma cell dyscrasia) screening panel?

From the Guidelines

A multiple myeloma screening panel typically includes serum protein electrophoresis (SPEP), serum immunofixation electrophoresis (SIFE), serum free light chain assay, complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis with urine protein electrophoresis (UPEP) as stated in the most recent guidelines 1. These tests help detect the presence of monoclonal proteins (M-proteins) produced by abnormal plasma cells.

• Additional testing often includes:
  • A 24-hour urine collection for protein electrophoresis
  • Beta-2 microglobulin levels
  • Lactate dehydrogenase (LDH) to assess disease burden and prognosis.
• Imaging studies such as skeletal surveys, MRI, CT scans, or PET scans are performed to identify bone lesions.
• Bone marrow aspiration and biopsy are essential for confirming the diagnosis by evaluating the percentage of plasma cells and performing cytogenetic testing. These comprehensive tests are necessary because multiple myeloma affects various body systems, particularly the bones and kidneys, and early detection allows for timely intervention before significant organ damage occurs. The combination of these tests provides clinicians with information about the presence, type, and extent of the disease, guiding treatment decisions, as supported by the guidelines 1.

From the Research

Multiple Myeloma Screening Panel

A multiple myeloma screening panel typically includes a combination of tests to diagnose and assess the extent of the disease. The following are some of the key components:

• Blood tests:
  • Complete blood count (CBC) with differential 2
  • Serum chemistries, including creatinine, lactate dehydrogenase, and beta2-microglobulin tests 2
  • Immunoglobulin studies, such as serum protein electrophoresis (SPEP) and serum free light chain (sFLC) assays 3, 4
• Urine tests:
  • 24-hour urine protein electrophoresis (UPEP) 3
• Imaging studies:
  • Skeletal survey, including X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans 5, 3, 6
• Bone marrow biopsy and evaluation 5, 2

Diagnostic Criteria

The diagnosis of multiple myeloma is based on the presence of certain criteria, including:

• Major criteria:
  • Plasmacytoma on tissue biopsy 2
  • Bone marrow plasma cell percentage ≥ 30% 2
  • High levels of M protein in serum or urine 2
• Minor criteria:
  • Bone marrow plasma cell percentage ≥ 10% but < 30% 2
  • Moderate levels of M protein in serum or urine 2
  • Lytic bone lesions 2

Staging and Risk Assessment

The Revised International Staging System (RISS) is used to stage multiple myeloma and assess the risk of progression 3. The RISS combines data from serum biomarkers, such as beta2-microglobulin, albumin, and lactate dehydrogenase, with malignant plasma cell genomic features found on fluorescence in situ hybridization (FISH) analysis.