From the Guidelines
To investigate multiple myeloma, a comprehensive approach including blood tests, urine studies, imaging, and bone marrow examination is required, as outlined in the most recent guidelines 1. This approach should begin with a complete blood count to assess for anemia, serum calcium to check for hypercalcemia, creatinine and BUN to evaluate kidney function, and serum protein electrophoresis with immunofixation to identify monoclonal proteins.
- Quantitative immunoglobulins and serum free light chain assay should be performed to measure abnormal antibody levels, as these tests have high sensitivity for screening for multiple myeloma and related plasma cell disorders 1.
- Urine studies should include 24-hour urine protein electrophoresis to detect Bence Jones proteins.
- Imaging studies are essential, with skeletal survey being traditional, though whole-body low-dose CT, MRI, or PET-CT may provide better sensitivity for bone lesions.
- Bone marrow aspiration and biopsy are crucial for diagnosis, requiring at least 10% clonal plasma cells or presence of plasmacytoma, and should include chromosome analysis by conventional karyotyping and fluorescence in situ hybridization (FISH) performed with the plasma cells obtained from bone marrow 1.
- Flow cytometry, FISH, and cytogenetic studies on the bone marrow sample help determine prognosis and guide treatment.
- Additional tests like beta-2 microglobulin and lactate dehydrogenase provide prognostic information. This systematic approach allows for accurate diagnosis, staging according to the Revised International Staging System, and appropriate treatment planning for multiple myeloma, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life. The diagnosis of symptomatic multiple myeloma requires the presence of 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, as outlined in the guidelines 1. It is also important to note that the serum free light chain assay is useful for monitoring disease response and progression in patients with non-secretory myeloma, and for documenting stringent complete response according to the International Myeloma Working Group Uniform Response Criteria 1.
From the Research
Investigating Multiple Myeloma
To investigate multiple myeloma, the following steps can be taken:
- Conduct serum protein electrophoresis (SPE) to detect the presence of M bands, which are indicative of multiple myeloma 2
- Analyze serum immunoglobulin profiles, including IgG, IgM, and IgA concentrations, to identify any abnormalities 2
- Use descriptive and inferential statistics techniques to analyze the data obtained from SPE and serum immunoglobulin profiles 2
- Consider the patient's age and gender, as the median age of multiple myeloma patients is 69 years and the ratio of male to female patients is 50:50 2
- Look for an increase in gamma globulin, which was present in 45.80% of patients with multiple myeloma, and a decrease in albumin, which was present in 12.21% of patients 2
- Investigate the relationship between the presence of M bands and serum immunoglobulins, as this study showed a significant increase in IgG concentration and a slight increase in IgM concentration in cases of M band presence and raised gamma 2