From the Guidelines
Investigating multiple myeloma requires a comprehensive approach including blood tests, urine studies, imaging, and bone marrow examination, as recommended by the most recent guidelines 1. To establish a diagnosis, the following tests should be performed:
- Initial blood tests: complete blood count, comprehensive metabolic panel, serum protein electrophoresis with immunofixation, serum free light chain assay, beta-2 microglobulin, and lactate dehydrogenase 1
- Urine studies: 24-hour urine collection for protein electrophoresis and immunofixation to detect Bence Jones proteins 1
- Imaging studies: skeletal survey or low-dose whole-body CT scan to identify bone lesions, and MRI for suspected spinal cord compression 1
- Bone marrow examination: bone marrow aspiration and biopsy to determine the percentage of plasma cells and identify high-risk genetic abnormalities, with samples sent for cytogenetics, FISH analysis, and flow cytometry 1 Additional testing should include assessment for hypercalcemia, renal function, anemia, and bone lesions (CRAB features) 1. It is essential to note that the diagnosis of symptomatic multiple myeloma requires the presence of ≥10% clonal plasma cells on bone marrow examination or a biopsy-proven plasmacytoma, and evidence of end-organ damage, such as hypercalcemia, renal insufficiency, anemia, or bone lesions 1. The serum free light chain assay is a valuable tool for monitoring disease response and progression, particularly in patients with non-secretory myeloma 1. By following this comprehensive approach, healthcare providers can establish an accurate diagnosis, determine the disease stage, and guide treatment decisions based on the patient's risk stratification 1.