Multiple Myeloma Diagnosis

The diagnosis of MULTIPLE MYELOMA is based upon the presence of characteristic signs and symptoms of the disease and on the results of tests of the blood and bone marrow. Several tests are used to determine the presence and severity of MULTIPLE MYELOMA. In some individuals with early MULTIPLE MYELOMA or related conditions, it may be necessary to repeat these tests periodically until the diagnosis is certain.

Oncologist from Modern Cancer Hospital Guangzhou explains that after MULTIPLE MYELOMA is confirmed, additional tests are used to check for the presence of impaired kidney function, anemia, thickening of the blood, and other complications of multiple myeloma.

Blood and urine tests for monoclonal protein — An abnormal protein produced by the plasma cells, called a monoclonal (M) protein (sometimes called a "paraprotein"), can be found in the blood or urine of almost all patients with MULTIPLE MYELOMA, which helps establish the diagnosis. M proteins serve no useful function, and may be responsible for increases in the thickness of the blood, kidney damage, or bleeding problems. In some patients, "free light chains" (FLCs), which represent a small portion of the paraprotein, are secreted either in addition to the M protein or by itself. These can be measured by an assay called the free light chain assay. The assay measures the two types of free light chains, kappa and lambda, which are made by plasma cells, and provides a ratio of the two.

However, doctor of Modern Cancer Hospital Guangzhou says that it is important to remember that not everyone with a monoclonal protein has MULTIPLE MYELOMA. The diagnosis also requires one or more abnormalities such as anemia, bone lesions, kidney failure, or high calcium levels in the blood.

Bone marrow examination — In most individuals with MULTIPLE MYELOMA, a bone marrow aspiration and biopsy (a collection of a small sample of bone marrow for laboratory analysis, usually taken from the hip) shows that plasma cells comprise an abnormally high percentage of bone marrow cells (more than 10 percent). It may be necessary to collect samples from different areas because MULTIPLE MYELOMA can affect the marrow of some bones but not others.

Imaging — In about 80 percent of individuals, routine x-rays show distinct, round (lytic) areas of bone erosion; generalized thinning of the bones; and/or fractures at the time of diagnosis. The bones most comultiple myelomaonly involved are the vertebrae, the ribs, the pelvic bones, and the bones of the thigh and upper arm.

In some people, such as those with bone pain but normal x-rays, other imaging tests may be done. These may include magnetic resonance imaging (MRI), computerized tomography (CT), or positron emission tomography (PET).

Genetic and chromosomal tests — Specialized tests may reveal genetic or chromosomal abnormalities of the plasma cells in individuals with MULTIPLE MYELOMA. The results of these tests are helpful for predicting the response to treatment and survival.

Oncologist from Modern Cancer Hospital Guangzhou further explains the criteria for diagnosis of multiple myeloma which are as follow:

A bone marrow aspirate or biopsy showing that at least 10 percent of the cells are plasma cells or the presence of a plasma cell tumor (called a plasmacytoma), plus at least one of the following two features:

•Evidence of damage to the body as a result of the plasma cell growth, such as severe bone damage, kidney failure, anemia, or high calcium in the blood, and/or

•Detection of one of the following findings: ≥60 percent plasma cells in the bone marrow; free light chain ratio of 100 or more (provided involved FLC level is at least 100 mg/L); or MRI showing more than one lesion (involving bone or bone marrow).