From the Research
Introduction to Multiple Myeloma
Multiple myeloma is a malignant disorder characterized by the proliferation of a single clone of plasma cells derived from β-cells in the bone marrow 1. It is essential to perform a comprehensive laboratory workup to diagnose and manage this condition effectively.
Laboratory Workup for Suspected Multiple Myeloma
The diagnostic workup for suspected multiple myeloma should include:
- Complete blood count with differential
- Serum chemistries
- Creatinine, lactate dehydrogenase, and beta2-microglobulin tests
- Immunoglobulin studies
- Skeletal survey
- Bone marrow evaluation 2
Key Laboratory Tests
The following laboratory tests are crucial in the diagnosis and management of multiple myeloma:
- Serum protein electrophoresis to detect monoclonal proteins
- Urine protein electrophoresis to detect Bence Jones protein
- Immunofixation to identify the type of monoclonal protein
- Cytogenetic testing to assess genetic abnormalities
- Beta2-microglobulin test to evaluate disease prognosis and response to treatment 3, 4
Interpretation of Laboratory Results
Laboratory results should be interpreted in the context of clinical symptoms and other diagnostic findings. The presence of anemia, high erythrocyte sedimentation rate, and low albumin/globulin ratio in elderly patients should alert the clinician to investigate for multiple myeloma 1. The absence of paraprotein in the blood does not exclude multiple myeloma.
Caveats and Differentials
It is essential to consider other conditions that may present with similar laboratory abnormalities, such as:
- Monoclonal gammopathy of undetermined significance (MGUS)
- Amyloidosis
- Liver cirrhosis
- Renal failure A comprehensive diagnostic workup and careful interpretation of laboratory results are necessary to establish an accurate diagnosis of multiple myeloma 1, 4
Treatment and Management
The treatment and management of multiple myeloma involve a multidisciplinary approach, including:
- Chemotherapy
- Autologous stem cell transplantation
- Thromboprophylaxis
- Bisphosphonate therapy
- Prophylaxis against infection Family physicians play a crucial role in assessing patients for infection, adverse treatment effects, and renal and thrombotic complications, and in managing issues related to pain, nutrition, and psychosocial support 2