From the Guidelines
The workup for multiple myeloma should include a comprehensive initial diagnostic evaluation, comprising history and physical examination, as well as baseline blood studies and biological assessments to differentiate between symptomatic and asymptomatic multiple myeloma.
Initial Diagnostic Workup
- Blood studies:
- Complete Blood Count (CBC) with differential and platelet counts
- Blood urea nitrogen (BUN)
- Serum creatinine and serum electrolytes
- Serum calcium
- Albumin
- Lactate dehydrogenase (LDH)
- Beta-2 microglobulin
- Serum and urine analyses:
- Quantitative immunoglobulin levels (IgG, IgA, and IgM)
- Serum protein electrophoresis (SPEP)
- Serum immunofixation electrophoresis (SIFE)
- Urine protein electrophoresis (UPEP)
- Urine immunofixation electrophoresis (UIFE)
- 24-hour urine for total protein
- Serum free light chain (FLC) assay: useful for diagnosing and monitoring nonsecretory myeloma and light chain amyloidosis, and for documenting stringent complete response according to the International Myeloma Working Group Uniform Response Criteria 1
Bone Marrow and Imaging Studies
- Bone marrow aspiration and biopsy: to detect quantitative and/or qualitative abnormalities of bone marrow plasma cells
- Imaging studies:
- Full skeleton radiographic survey or whole-body, low-dose CT to evaluate lytic bone lesions
- Optional magnetic resonance imaging (MRI) for greater detail, especially if spinal cord compression is suspected
Cytogenetic and Molecular Studies
- Chromosome analysis: using conventional karyotyping (cytogenetics) and fluorescence in situ hybridization (FISH) to detect chromosomal abnormalities, such as deletions, translocations, or amplifications
- Specific chromosomal abnormalities: including deletion of 17p13, t(4;14), t(14;16), and t(11;14), which have prognostic implications 1 These studies are essential for establishing a diagnosis, assessing disease severity, and guiding treatment decisions in patients with multiple myeloma 1.
From the Research
Diagnostic Workup for Multiple Myeloma
The diagnostic workup for multiple myeloma includes:
- Measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels 2
- Serum protein electrophoresis with immunofixation 2, 3
- 24-hour urine protein electrophoresis 2
- Full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging 2
- Complete blood count with differential 3
- Serum chemistries; creatinine, lactate dehydrogenase, and beta2-microglobulin tests 3
- Immunoglobulin studies 3
- Skeletal survey 3
- Bone marrow evaluation 3
Staging and Prognosis
The Revised International Staging System combines data from serum biomarkers and malignant plasma cell genomic features to assess estimated progression-free survival and overall survival 2
- The system uses serum biomarkers such as β2 microglobulin, albumin, and lactate dehydrogenase, as well as genomic features found on fluorescence in situ hybridization, such as t(4;14), del(17p), and t(14;16) 2
Treatment Approaches
Treatment approaches for multiple myeloma include:
- Induction therapy with a combination of an injectable proteasome inhibitor, an oral immunomodulatory agent, and dexamethasone 2
- Autologous hematopoietic stem cell transplantation followed by maintenance lenalidomide 2
- Thromboprophylaxis, bisphosphonate therapy, and prophylaxis against infection 3
- Management of issues related to pain, nutrition, and psychosocial support 3