Multiple Myeloma: Diagnosis Overview

Multiple Myeloma:

Diagnosis Overview

If a patient is presenting with symptoms that might suggest a diagnosis of multiple myeloma, several tests are done to determine a patient’s prognosis in addition to a physical exam.1

Laboratory Tests1
  • Complete blood counts measure red cell, white cell, and platelet levels in the blood.
  • Blood chemistry tests evaluate blood creatinine, albumin, calcium, and other electrolyte levels. A blood test to measure lactic dehydrogenase levels may also be completed.
  • Urine protein electrophoresis and urine immunofixation tests find myeloma protein that filtered through the kidney, in addition to measuring the amount of myeloma protein that exists.
  • Quantitative immunoglobulins measure any abnormally high or low immunoglobulin levels.
  • Serum protein electrophoresis determines blood antibodies and can locate a monoclonal antibody.
  • Immunofixation or immunoelectrophoresis uncovers the specific type of antibody.
  • Serum free light chain is a blood test that can assess blood levels and analyze the light chain ratio. This test is most useful in rare myeloma cases when an M protein is not found by serum protein electrophoresis.
  • Beta-2 microglobulin is a protein that can be suggestive of a patient’s prognosis, with high levels indicating more advanced disease.
Biopsies1

Bone marrow biopsies examine the size, appearance, and shape of cells within the bone marrow, as well as how the cells are arranged and if there are any myeloma cells present.

  • Aspirate from the bone marrow biopsy may be sent for the following tests:
    • Immunohistochemistry
    • Flow cytometry
    • Cytogenetics
    • Fluorescent in situ hybridization

Fine needle aspiration (FNA) biopsies remove a small amount of tissue from either a tumor or lymph node using a thin needle. The advantage of this method is that it does not require surgery; however, the needle may not be able to remove enough tissue in some cases to determine an official diagnosis.

Core needle biopsies use a larger needle to collect a larger sample of tissue, but is comparable to FNA.

Imaging Tests1

These tests can be used for a number of reasons, including to investigate suspicious areas that could be cancer, determine where a cancer has spread, and to see if treatment is working effectively:

  • Bone x-rays
  • Positron emission tomography scan
  • Computed tomography scan
  • Echocardiogram
  • Magnetic resonance imaging scan
DIAGNOSTIC CRITERIA2

A definitive diagnosis of multiple myeloma is dependent on specific criteria:

  • Malignant plasma cells, with a plasma cell level >10% from the sample of bone marrow biopsy
  • Abnormally large number of monoclonal protein, also known as “M spike”
  • Indication of end-organ damage, as determined by CRAB (Calcium elevation, Renal dysfunction, Anemia, Bone lesions) criteria, or 60% of plasma cells in the bone marrow if there are no CRAB symptoms

As a nurse practitioner, my role in the care of patients with multiple myeloma is both a privilege and a responsibility. Understanding the process of diagnosing and treating this complex disease is crucial for providing the best care possible and ensuring that our patients are empowered to make informed decisions about their health. By understanding the diagnostic process, tailoring individualized treatment plans, and ensuring informed decision-making, we strive to provide care that addresses all aspects of the well-being of our patients.

Donna D. Catamero, ANP‑BC, OCN, CCRC

References: 1. Tests to Find Multiple Myeloma. American Cancer Society. Updated February 28, 2018. Accessed August 2, 2024. https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/testing.html 2. Diagnosis. Leukemia and Lymphoma Society. Accessed August 2, 2024. https://www.lls.org/myeloma/diagnosis

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