Szpiczak mnogi – Diagnostyka i diagnoza

Szpiczak mnogi
Diagnostyka i diagnoza

Szpiczak mnogi to złośliwy nowotwór plazmocytów charakteryzujący się obecnością ≥10% klonalnych plazmocytów w szpiku kostnym lub potwierdzoną plazmocytomą. Diagnoza opiera się na kryteriach IMWG, które obejmują klasyczne objawy CRAB: hiperkalcemia (Ca >2,75 mmol/l), niewydolność nerek (kreatynina >177 μmol/l), niedokrwistość (Hb <10 g/dl) oraz zmiany osteolityczne w badaniach obrazowych. Dodatkowo, wprowadzono biomarkery SLiM: ≥60% plazmocytów w szpiku, stosunek wolnych łańcuchów lekkich ≥100 (przy stężeniu ≥100 mg/l) oraz obecność >1 zmiany ogniskowej w MRI ≥5 mm. Diagnostyka obejmuje morfologię, elektroforezę białek, immunofiksację, badanie wolnych łańcuchów lekkich, ocenę beta-2-mikroglobuliny, LDH, albuminy oraz badania moczu (UPEP, immunofiksacja). Biopsja szpiku kostnego i badania genetyczne (FISH, cytogenetyka, NGS) dostarczają informacji prognostycznych i wpływają na terapię. Obrazowanie (RTG, CT, MRI, PET-CT) służy do oceny zajęcia kości i aktywności choroby.

Diagnostyka szpiczaka mnogiego

Szpiczak mnogi jest nowotworem złośliwym plazmocytów, który najczęściej charakteryzuje się występowaniem nieprawidłowych klonalnych komórek plazmatycznych w szpiku kostnym. Diagnoza szpiczaka mnogiego może być wyzwaniem, szczególnie we wczesnych etapach choroby, kiedy objawy są niespecyficzne lub całkowicie nieobecne. Wczesne wykrycie jest kluczowe dla pomyślnego leczenia, dlatego diagnostyka wymaga kompleksowego podejścia obejmującego różnorodne badania¹².

Kryteria diagnostyczne

Zgodnie z kryteriami Międzynarodowej Grupy Roboczej ds. Szpiczaka (International Myeloma Working Group, IMWG), do rozpoznania szpiczaka mnogiego wymagane jest spełnienie następujących warunków¹²:

Obecność co najmniej 10% klonalnych plazmocytów w szpiku kostnym lub potwierdzona biopsyjnie plazmocytoma (guz plazmocytowy) w tkance kostnej lub pozaszpikowej¹²
Białko monoklonalne (białko M) w surowicy i/lub moczu (z wyjątkiem przypadków prawdziwego niewydzielającego szpiczaka)
Przynajmniej jeden z objawów uszkodzenia narządowego związanego z szpiczakiem mnogim (kryteria CRAB) lub zdarzeń definiujących szpiczaka (MDE)

W 2014 roku IMWG zaktualizowała kryteria diagnostyczne, wprowadzając biomarkery złośliwości jako zdarzenia definiujące szpiczaka (MDE)¹².

Kryteria CRAB

Kryteria CRAB obejmują uszkodzenia narządowe przypisywane szpiczakowi mnogiemu¹²:

C – hiperkalcemia (poziom wapnia skorygowany >2,75 mmol/l lub >11 mg/dl)
R – niewydolność nerek (klirens kreatyniny 177 μmol/l czyli >2 mg/dl)
A – niedokrwistość (hemoglobina <10 g/dl lub co najmniej 2 g/dl poniżej dolnej granicy normy)
B – zmiany kostne (jedna lub więcej zmian osteolitycznych w badaniach obrazowych)

Biomarkery SLiM

Dodatkowo, IMWG wprowadziła tzw. biomarkery SLiM, które stanowią zdarzenia definiujące szpiczaka (MDE)¹²:

S – ≥60% klonalnych plazmocytów w szpiku kostnym
Li – stosunek wolnych łańcuchów lekkich w surowicy (zaangażowany/niezaangażowany) ≥100 (przy stężeniu zaangażowanego łańcucha lekkiego co najmniej 100 mg/l)
M – więcej niż jedna zmiana ogniskowa w badaniu MRI (o wielkości co najmniej 5 mm)

Łącznie kryteria CRAB i biomarkery SLiM znane są jako zdarzenia definiujące szpiczaka (MDE)¹.

Badania diagnostyczne

Badania krwi

Badania krwi są podstawowym narzędziem w diagnostyce szpiczaka mnogiego. Obejmują one¹²:

Morfologia krwi obwodowej – może wykazać niedokrwistość, spadek liczby płytek krwi i białych krwinek, co jest typowe dla szpiczaka¹²
Elektroforeza białek surowicy (SPEP) – pozwala wykryć białko monoklonalne (białko M) w surowicy¹²
Immunofiksacja surowicy – umożliwia identyfikację typu białka monoklonalnego (IgG, IgA, IgD, IgM lub IgE) i łańcucha lekkiego (kappa lub lambda)¹
Badanie wolnych łańcuchów lekkich w surowicy – dostarcza informacji o stężeniu łańcuchów lekkich kappa i lambda oraz ich wzajemnym stosunku¹²
Stężenie beta-2-mikroglobuliny – podwyższony poziom wskazuje na bardziej zaawansowaną chorobę, służy do oceny rokowania¹²
Poziom wapnia w surowicy – hiperkalcemia jest częstym objawem szpiczaka¹
Badania czynności nerek – stężenie kreatyniny, mocznika (BUN) do oceny funkcji nerek¹
Dehydrogenaza mleczanowa (LDH) – podwyższony poziom sugeruje większą aktywność choroby i gorsze rokowanie¹²
Albumina – obniżony poziom może wskazywać na bardziej agresywną postać szpiczaka¹
Ilościowe oznaczenie immunoglobulin – pozwala określić poziom różnych klas przeciwciał¹²

Badania moczu

Badania moczu stanowią ważny element diagnostyki szpiczaka mnogiego¹:

Elektroforeza białek moczu (UPEP) – wykrywa białko Bence’a Jonesa (wolne łańcuchy lekkie) w moczu¹²
Immunofiksacja moczu – identyfikuje rodzaj białka monoklonalnego w moczu¹
Zbiórka dobowa moczu – umożliwia ilościową ocenę wydalania białka¹²

Badania szpiku kostnego

Badanie szpiku kostnego jest niezbędne do potwierdzenia diagnozy szpiczaka mnogiego¹²:

Biopsja aspiracyjna szpiku kostnego – pobranie płynnej części szpiku kostnego za pomocą igły, najczęściej z talerza kości biodrowej¹²
Trepanobiopsja szpiku kostnego – pobranie fragmentu tkanki stałej szpiku kostnego¹²

Materiał pobrany ze szpiku kostnego jest następnie badany pod kątem obecności i odsetka plazmocytów nowotworowych. Poziom plazmocytów przekraczający 10% potwierdza diagnozę szpiczaka, a wyższy odsetek wskazuje na bardziej zaawansowaną chorobę¹.

Badania cytogenetyczne i molekularne

Badania genetyczne dostarczają ważnych informacji prognostycznych i mogą wpływać na wybór terapii¹²:

Fluorescencyjna hybrydyzacja in situ (FISH) – wykrywa zmiany genetyczne w komórkach szpiczaka, takie jak del(17p), t(4;14), t(14;16)¹²
Cytogenetyka klasyczna – analiza nieprawidłowości chromosomalnych¹²
Cytometria przepływowa – pomaga odróżnić prawidłowe plazmocyty od nowotworowych¹²
Sekwencjonowanie genomu – dostarcza cennych informacji o profilu genetycznym szpiczaka¹²

Badania obrazowe

Badania obrazowe są istotne w diagnostyce szpiczaka mnogiego, ponieważ pozwalają ocenić stopień zajęcia kości i wykryć zmiany osteolityczne¹:

Badanie radiologiczne układu kostnego (skeletal survey) – tradycyjne badanie pozwalające wykryć zmiany osteolityczne¹²
Niskodawkowa tomografia komputerowa całego ciała – bardziej czuła metoda wykrywania zmian kostnych niż konwencjonalne zdjęcia RTG¹²
Rezonans magnetyczny (MRI) – szczególnie przydatny w ocenie zajęcia szpiku kostnego i wykrywaniu zmian ogniskowych¹²
Pozytonowa tomografia emisyjna (PET-CT) – umożliwia ocenę aktywności metabolicznej zmian i jest skuteczna w identyfikacji rozmieszczenia choroby¹²

Klasyfikacja i stopnie zaawansowania

System Staging ISS

Międzynarodowy System Stopniowania (International Staging System, ISS) jest powszechnie stosowanym systemem oceny zaawansowania szpiczaka mnogiego. Opiera się na poziomach beta-2-mikroglobuliny i albuminy w surowicy¹²:

Stopień I: beta-2-mikroglobulina <3,5 mg/l i albumina ≥3,5 g/dl
Stopień II: ani stopień I, ani stopień III (beta-2-mikroglobulina <3,5 mg/l i albumina <3,5 g/dl lub beta-2-mikroglobulina 3,5-5,5 mg/l bez względu na poziom albuminy)
Stopień III: beta-2-mikroglobulina ≥5,5 mg/l

Zrewidowany System Staging (R-ISS)

Zrewidowany Międzynarodowy System Stopniowania (Revised International Staging System, R-ISS) uwzględnia dodatkowo poziom dehydrogenazy mleczanowej (LDH) i obecność wysokiego ryzyka zmian cytogenetycznych wykrytych metodą FISH¹²:

Stopień I R-ISS: Stadium I ISS (beta-2-mikroglobulina <3,5 mg/l i albumina ≥3,5 g/dl), prawidłowe LDH i brak wysokiego ryzyka zmian cytogenetycznych
Stopień II R-ISS: niespełniający kryteriów stopnia I ani III
Stopień III R-ISS: Stadium III ISS (beta-2-mikroglobulina ≥5,5 mg/l) oraz podwyższone LDH lub obecność wysokiego ryzyka zmian cytogenetycznych [del(17p), t(4;14) lub t(14;16)]

Stany prekursorowe szpiczaka

W diagnostyce różnicowej szpiczaka mnogiego należy uwzględnić stany prekursorowe¹²:

Gammapatia monoklonalna o nieokreślonym znaczeniu (MGUS) – charakteryzuje się obecnością białka M na poziomie <3 g/dl, <10% plazmocytów w szpiku kostnym i brakiem objawów końcowego uszkodzenia narządów (kryteria CRAB)
Tlący się szpiczak mnogi (SMM) – charakteryzuje się wyższym poziomem białka M (≥3 g/dl) i/lub 10-60% plazmocytów w szpiku kostnym, ale bez objawów końcowego uszkodzenia narządów

Dokładna diagnostyka różnicowa między tymi stanami jest kluczowa, ponieważ każdy z nich wymaga innego podejścia terapeutycznego¹².

Diagnostyka różnicowa

W diagnostyce różnicowej szpiczaka mnogiego należy uwzględnić¹²:

Gammapatia monoklonalna o nieokreślonym znaczeniu (MGUS)
Tlący się szpiczak mnogi (SMM)
Odosobniony guz plazmocytowy (plasmacytoma) – zlokalizowany guz plazmocytowy kości lub tkanek miękkich bez obecności szpiczaka mnogiego lub plazmocytozy szpiku
Amyloidoza pierwotna – często wtórna do szpiczaka mnogiego, ale może rozwinąć się bez spełnienia kryteriów diagnostycznych szpiczaka
Inne nowotwory hematologiczne – takie jak chłoniaki, przewlekła białaczka limfocytowa
Przerzuty nowotworowe do kości

Rola badań laboratoryjnych w monitorowaniu leczenia

Badania laboratoryjne nie tylko odgrywają kluczową rolę w diagnostyce szpiczaka mnogiego, ale także są niezbędne w monitorowaniu odpowiedzi na leczenie¹²:

Okresowe oznaczanie poziomu białka M w surowicy i moczu – pozwala ocenić skuteczność leczenia i wykryć nawrót choroby
Regularne badanie wolnych łańcuchów lekkich – szczególnie ważne u pacjentów z niewydzielającym lub oligowydzielającym szpiczakiem
Powtarzanie biopsji szpiku kostnego – pomocne w ocenie odpowiedzi na leczenie, zwłaszcza przy podejrzeniu remisji lub progresji
Badania obrazowe – do oceny zmian kostnych i odpowiedzi na leczenie

Wyzwania diagnostyczne

Diagnostyka szpiczaka mnogiego może być wyzwaniem z kilku powodów¹²:

Niespecyficzne objawy kliniczne we wczesnych etapach choroby
Różnorodność prezentacji klinicznej
Rzadkość występowania (ok. 1,6% wszystkich nowotworów)
Istnienie wariantów szpiczaka, które mogą nie wykazywać typowych cech (np. niewydzielający szpiczak mnogi)
Nakładanie się objawów z innymi chorobami

Szybka ocena diagnostyczna

Diagnostyka szpiczaka mnogiego powinna być przeprowadzona szybko i dokładnie, szczególnie w przypadku podejrzenia zaawansowanej choroby wymagającej natychmiastowego leczenia¹².

Lekarz powinien przeprowadzić następujące kroki¹:

Dokładny wywiad medyczny i badanie fizykalne
Podstawowe badania laboratoryjne krwi i moczu
Badania obrazowe układu kostnego
Biopsję szpiku kostnego
Badania specjalistyczne (cytogenetyczne, molekularne)

W przypadku potwierdzenia diagnozy szpiczaka mnogiego, pacjent powinien zostać skierowany do hematologa lub onkologa w celu ustalenia planu leczenia¹.

Tabela 1. Kryteria diagnostyczne aktywnego szpiczaka mnogiego wg IMWG
Kryterium	Opis
Podstawowe warunki	Klonalne plazmocyty w szpiku kostnym ≥10% lub plazmocytoma potwierdzona biopsją
ORAZ przynajmniej jeden z poniższych objawów CRAB lub biomarkerów SLiM:
C – Hiperkalcemia	Poziom wapnia w surowicy >2,75 mmol/l (>11 mg/dl)
R – Niewydolność nerek	Klirens kreatyniny 177 μmol/l (>2 mg/dl)
A – Niedokrwistość	Hemoglobina <10 g/dl lub co najmniej 2 g/dl poniżej dolnej granicy normy
B – Zmiany kostne	Jedna lub więcej zmian osteolitycznych w badaniach obrazowych (RTG, CT, PET-CT)
S – Plazmocyty w szpiku	≥60% klonalnych plazmocytów w szpiku kostnym
Li – Łańcuchy lekkie	Stosunek wolnych łańcuchów lekkich w surowicy (zaangażowany/niezaangażowany) ≥100 (przy stężeniu zaangażowanego łańcucha co najmniej 100 mg/l)
M – Zmiany w MRI	Więcej niż jedna zmiana ogniskowa w badaniu MRI o wielkości co najmniej 5 mm

Nowoczesne metody diagnostyczne

W ostatnich latach nastąpił znaczący postęp w technikach diagnostycznych szpiczaka mnogiego¹²:

Zaawansowane techniki obrazowania (niskodawkowa CT całego ciała, PET-CT, MRI całego ciała) – bardziej czułe w wykrywaniu zmian kostnych niż konwencjonalne badania radiologiczne
Cytometria przepływowa wieloparametryczna – pozwala na dokładniejszą identyfikację i charakterystykę komórek szpiczakowych
Sekwencjonowanie nowej generacji (NGS) – umożliwia wykrycie mutacji genetycznych w komórkach szpiczakowych
Ocena minimalnej choroby resztkowej (MRD) – pozwala na wykrycie nawet niewielkiej liczby komórek szpiczakowych po leczeniu

Podsumowanie

Diagnostyka szpiczaka mnogiego wymaga kompleksowego podejścia i zastosowania wielu różnych badań. Kluczowe jest wczesne rozpoznanie choroby, ponieważ umożliwia to szybsze wdrożenie odpowiedniego leczenia i poprawę rokowania¹².

Podstawowe narzędzia diagnostyczne obejmują badania laboratoryjne krwi i moczu, badania obrazowe układu kostnego oraz biopsję szpiku kostnego. Dodatkowo, badania cytogenetyczne i molekularne dostarczają ważnych informacji prognostycznych i mogą wpływać na wybór terapii¹².

Aktualne kryteria diagnostyczne IMWG, uwzględniające zarówno klasyczne kryteria CRAB, jak i biomarkery SLiM, umożliwiają wcześniejsze wykrycie choroby i wdrożenie leczenia przed wystąpieniem nieodwracalnych uszkodzeń narządowych¹².

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Materiały źródłowe

#1
https://www.nhs.uk/conditions/multiple-myeloma/diagnosis/
Multiple myeloma can be difficult to diagnose because it’s an uncommon type of cancer that usually has few or no symptoms in the early stages. […] If multiple myeloma is suspected, you’ll be referred to hospital to see a haematologist (a doctor who specialises in conditions affecting the blood) for further tests and scans. […] A bone marrow biopsy is usually needed to confirm multiple myeloma. […] The samples of bone marrow and bone will then be checked for cancerous plasma cells.
#1 Multiple myeloma – Wikipedia
https://en.wikipedia.org/wiki/Multiple_myeloma
Multiple myeloma is diagnosed based on blood or urine tests finding abnormal antibody proteins (often using electrophoretic techniques revealing the presence of a monoclonal spike in the results, termed an m-spike), bone marrow biopsy finding cancerous plasma cells, and medical imaging finding bone lesions. […] Another common finding is high blood calcium levels. […] In 2003, the IMWG agreed on diagnostic criteria for symptomatic myeloma, asymptomatic myeloma, and MGUS, which was subsequently updated in 2009. […] Symptomatic myeloma (all three criteria must be met): Clonal plasma cells 10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma). […] A monoclonal protein (myeloma protein) in either serum or urine and it has to be more than 3g/dL (except in cases of true nonsecretory myeloma).
#1 Multiple myeloma – Wikipedia
https://en.wikipedia.org/wiki/Multiple_myeloma
Evidence of end-organ damage felt related to the plasma cell disorder (related organ or tissue impairment, CRAB): Hypercalcemia (corrected calcium 2.75 mmol/L, 11 mg/dL). […] Renal failure (kidney insufficiency) attributable to myeloma. […] Anemia (hemoglobin 10 g/dL). […] Bone lesions (lytic lesions or osteoporosis with compression fractures). […] In 2014, the IMWG updated its criteria further to include biomarkers of malignancy. […] These biomarkers are 60% clonal plasma cells, a serum involved / uninvolved free light chain ratio 100 (the concentration of the involved free light chain must be 100 mg/L) and more than one focal lesion 5 mm by MRI. […] Together, these biomarkers and the CRAB criteria are known as myeloma-defining events (MDEs).
#1 Multiple myeloma – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
Sometimes a health care professional finds multiple myeloma during a blood test for another condition. Other times your symptoms may lead your health care professional to test for multiple myeloma. […] Tests and procedures to diagnose multiple myeloma include: […] Blood tests. The M proteins made by myeloma cells can show up in a sample of blood. Blood tests also might find another protein myeloma cells make, called beta-2-microglobulin. […] Other blood tests give your health care team clues about your diagnosis. These tests might include tests that look at kidney function, blood cell counts, calcium levels and uric acid levels. […] Urine tests. M proteins can show up in urine samples. In urine, the proteins are called Bence Jones proteins. […] Bone marrow tests. Bone marrow biopsy and bone marrow aspiration are used to collect bone marrow samples for testing. Bone marrow has a solid and a liquid part. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. In a bone marrow aspiration, a needle is used to draw a sample of the fluid. The samples are typically taken from the hip bone.
#1 Multiple Myeloma diagnosis and monitoring | Sebia | en-US
https://www.sebia.com/en-us/pathologies/multiple-myeloma-diagnosis/
World leader in diagnosis and monitoring of Multiple Myeloma patients. […] Serum and urine protein electrophoresis and their immunological characterization are the gold standard for Multiple Myeloma diagnosis, for monitoring the disease and to assess the patients response to treatment. […] Protein electrophoresis is recommended by IMWG (International Myeloma Working Group) for screening serum and urine samples for protein abnormality detection. […] Once the Monoclonal protein is identified (or suspected), it must be characterized by an immunofixation or immunotyping test to identify the M-Protein type (IgG, IgA, IgM, IgD, IgE) and light chain (kappa or Lambda) involved. […] The serum Free Light Chains is an important test in the diagnosis and monitoring of Multiple Myeloma patients.
#1 Multiple Myeloma – Hematology and Oncology – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/hematology-and-oncology/plasma-cell-disorders/multiple-myeloma
Protein and immunofixation electrophoresis are carried out on a serum sample and on a urine sample concentrated from a 24-hour collection to identify, quantify, and characterize M-protein. […] Immunofixation electrophoresis can identify the immunoglobulin class of the M-protein (IgG, IgA, or uncommonly IgD, IgM, or IgE) and can often detect light-chain protein if serum immunoelectrophoresis is negative; immunofixation electrophoresis is done even when the serum test is negative if multiple myeloma is strongly suspected. […] Serum free light-chain analysis with delineation of kappa and lambda ratios or differences between the involved and uninvolved light chains helps confirm the diagnosis and can also be used to monitor efficacy of therapy and provide prognostic data. […] Diagnosis and differentiation from other malignancies (eg, metastatic carcinoma, lymphoma, leukemia) and from monoclonal gammopathy of undetermined significance typically require multiple criteria: Clonal bone marrow plasma cells or plasmacytoma, M-protein in plasma and/or urine, Organ impairment (hypercalcemia, renal insufficiency, anemia, or bony lesions). […] In patients without serum M protein, myeloma is indicated by Bence Jones proteinuria 200 mg/24 hour or abnormal serum free light chain levels, osteolytic lesions (without evidence of metastatic cancer or granulomatous disease), and sheets or clusters of plasma cells in the bone marrow.
#1 How We Diagnose Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/diagnosis
Genetic studies, including metaphase cytogenetics and fluorescence in situ hybridization, are performed on the bone marrow sample to identify genetic changes that have occurred in the myeloma cells. […] You will have lab tests that include comprehensive blood chemistries, complete blood count, serum and urine protein electrophoresis, the serum free light chain assay, lactate dehydrogenase, and beta2 microglobulin. […] The serum or urine protein electrophoresis identifies the presence, type, and concentration of the M-protein, or monoclonal protein. […] The serum free light chain assay provides the concentration of the two light chains that are found in the body the kappa and lambda light chains and the ratio between these light chains. […] Staging in multiple myeloma has traditionally been done using the Durie Salmon staging system, the International Staging System (ISS), or the Revised International Staging System (R-ISS). […] It is important to note that no staging system is perfect and that patients with advanced stage disease can do very well over time with appropriate therapy. […] Our diagnostic team provides second opinions, including for challenging or difficult cases.
#1 Tests for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/testing.html
If signs, symptoms, or the results of certain lab tests suggest you might have multiple myeloma, other tests will be done to find out for sure. […] If multiple myeloma is found, further tests might also be done to learn more about it and help decide the best treatments. […] Different types of lab tests can be helpful in finding multiple myeloma, learning more about it, and seeing how well treatment is working. […] Blood tests measuring levels of lactic dehydrogenase (LDH) and beta-2 microglobulin (B2M) are also often done. Levels of these substances are used to help determine the stage of the myeloma. High levels of either of these substances often means the disease is more advanced. […] Finding a monoclonal antibody in the blood is often a first step in diagnosing multiple myeloma.
#1 Multiple Myeloma Blood Tests: Purpose, Procedure, and Results
https://www.healthline.com/health/multiple-myeloma/multiple-myeloma-blood-test
A complete blood count, chemistry profile, immunoglobulin test, and light chain assay are among the important blood tests doctors use to help diagnose multiple myeloma. […] Doctors can help diagnose multiple myeloma using blood tests. These measure changes in the levels of blood cells or proteins that may mean you have cancerous cells in your bone marrow. […] With multiple myeloma, your red blood cells and platelets might decrease as your bone marrow loses its ability to produce enough of these blood cells. […] Your white blood cells might increase in early stages of multiple myeloma but also decrease as cancer affects your bone marrow. […] With a blood chemistry profile, healthcare professionals use a blood sample to monitor levels of substances in your blood that multiple myeloma can affect, including: calcium, which can rise to very high levels when you have multiple myeloma; albumin, which can lower drastically when you have aggressive forms of multiple myeloma; creatinine, which can increase due to kidney complications related to multiple myeloma.
#1 Diagnosis of multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/diagnosis
A quantitative immunoglobulin (Ig) test measures the amount of different antibodies in the blood to check if they are high or low. There are 5 types of immunoglobulins IgA, IgD, IgE, IgG and IgM. A high level of one of these immunoglobulins is often present in multiple myeloma. IgG and IgA are the immunoglobulins most often found in high amounts in people with multiple myeloma. […] SPEP checks for the presence of M-protein in the blood. M-protein is an immunoglobulin that is found in high amounts in a person with multiple myeloma. […] UPEP checks for the presence of M-protein in urine that has been collected over 24 hours. UPEP can also detect part of an M-protein called an immunoglobulin light chain (also called a free light chain or Bence-Jones protein). […] A serum free light chain test looks for immunoglobulin light chains (called free light chains or Bence-Jones proteins) in the blood. This can be helpful in diagnosing multiple myeloma if an M-protein isn’t found by SPEP.
#1 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2008/1001/p853.html
Serum and urine protein immunofixation are also recommended because immunofixation can be diagnostic even with a normal or nonspecific protein electrophoretic pattern. […] Bone marrow aspirate analysis should be performed in patients with abnormal serum or urine proteins and may require multiple samples because findings may be focal. […] Most patients with symptomatic multiple myeloma have increased M protein levels (more than 3 g per dL) on serum protein electrophoresis. […] The type and amount of urine monoclonal light chains are typically measured with urine protein immunofixation. […] There is no standard imaging work-up for multiple myeloma, but a skeletal radiograph survey is generally recommended. […] Magnetic resonance imaging (MRI) is the preferred technique for suspected spinal compression or soft-tissue plasmacytomas. […] Several additional biochemical and genetic markers have been shown to correlate with prognosis in patients with multiple myeloma, but they should not be used for diagnosis.
#1 Multiple Myeloma Diagnosis – Florida Cancer Affiliates
https://floridacancer.com/cancers-blood-diseases-info/blood-cancers/multiple-myeloma/diagnosis11/
The lab also checks for high levels of calcium. […] To see how well the kidneys are working, the lab tests for creatinine. […] The lab checks for Bence Jones protein, a type of M protein, in urine. The lab measures the amount of Bence Jones protein in urine collected over a 24-hour period. If the lab finds a high level of Bence Jones protein in your urine sample, doctors will monitor your kidneys. Bence Jones protein can clog the kidneys and damage them. […] You may have x-rays to check for broken or thinning bones. An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma. […] A biopsy is the only sure way to know whether myeloma cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hip bone or another large bone. A pathologist uses a microscope to check the tissue for myeloma cells.
#1 Diagnostic Testing for Multiple Myeloma | Blood, Urine, & Bone Tests
https://themmrf.org/diagnosis-and-treatment/diagnostic-testing/
A level of myeloma cells in the bone marrow that exceeds 10% confirms a diagnosis of multiple myeloma; a higher percentage indicates more extensive disease. […] It is strongly recommended that multiple myeloma patients undergo genomic sequencing when possible. Genome sequencing can provide valuable information about your prognosis, your treatment options, and how your myeloma is changing in response to treatment. […] Along with blood and urine tests, imaging tests can provide valuable information about the status of your myeloma. Imaging tests conducted on bone help the healthcare team diagnose multiple myeloma and are used to monitor the disease during treatment.
#1 Multiple myeloma – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383
The samples go to a lab for testing. In the lab, tests look for myeloma cells. Other special tests give your health care team more information about your myeloma cells. For example, the fluorescence in situ hybridization test looks for changes in the cells’ genetic material, called DNA. […] Imaging tests. Imaging tests can show bone problems linked with multiple myeloma. Tests may include an X-ray, MRI scan, CT scan, or positron emission tomography scan, also called PET scan. […] The results of your tests help your health care team decide your myeloma’s stage. In multiple myeloma, the stages range from 1 to 3. The stage tells your health care team how quickly your myeloma is growing. A stage 1 multiple myeloma is growing slowly. As the stages get higher, the myeloma becomes more aggressive. A stage 3 multiple myeloma is getting worse quickly. […] Your health care team uses the multiple myeloma stage and risk level to understand your prognosis and plan your treatment.
#1 Diagnosis of multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/diagnosis
The most common type of tissue biopsy for diagnosing multiple myeloma is a bone marrow aspiration and biopsy. […] The report from the lab will confirm whether or not there are abnormal plasma cells in the sample. […] Cytogenetic tests (chromosomal analysis) show chromosomal changes which affect some people with multiple myeloma. The results of cytogenetic studies also help doctors plan treatment and predict how well the treatment will work. […] Karyotyping can find large chromosomal changes like a missing part of a chromosome or an entire missing chromosome. Chromosome 13 is sometimes deleted (missing) in people with multiple myeloma. Karyotyping can also find small chromosomal changes like a rearranged chromosome. Chromosome 14 is commonly rearranged (called a translocation) in people with multiple myeloma. […] Flow cytometry can help doctors tell the difference between abnormal plasma cells (called myeloma cells) and normal plasma cells.
#1 Multiple myeloma | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/multiple-myeloma-1?lang=us
The myeloma defining events can be recalled with the mnemonic SLiM-CRAB. […] Multiple myeloma is a common malignancy in patients above 40; 70% of cases are diagnosed between ages 50 and 70 with a median age of diagnosis being 70 years; there is a male predilection (M: F 2:1). […] Radiology has a number of roles in the diagnosis and management for multiple myeloma: suggest the diagnosis / exclude other causes, assess possible mechanical complications (e.g. pathological fracture), assess disease progression. […] A skeletal survey is essential not only for the diagnosis of multiple myeloma but also in pre-empting potential complications (e.g. pathological fracture) and assessing response to therapy. […] Whole-body low dose CT is more accurate than a skeletal survey with a sensitivity of ~70% and specificity of ~90% with a dose 1-2x that of a skeletal survey. […] A whole-body MRI technique may be deployed. MRI is more sensitive in detecting multiple lesions compared to the standard plain film skeletal survey and CT. […] FDG PET-CT is effective in identifying the distribution of disease.
#1 Diagnosing Multiple Myeloma and Stages 1, 2, 3 | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/multiple-myeloma/stages
Urine (pee) tests show if you have signs of multiple myeloma. […] Doctors use imaging tests to help find and diagnose multiple myeloma, recommend treatments, and monitor how well you respond to therapy. […] Before we stage multiple myeloma, we describe what kind of plasma cell disorder you have. Diagnostic tests tell us if you have symptoms and signs of organ damage. […] Staging is part of the diagnosis process. It tells us how advanced a cancer is. It describes the tumors size, location, and how far it has spread. Staging helps your care team choose the best treatment and follow-up care for you. […] To describe the stage, doctors use the International Staging System (ISS) and the Revised International Staging System (R-ISS). These scoring systems get information from blood tests. […] There are 3 stages of myeloma, from 1 to 3. The lower the number, the less the cancer has spread.
#1 What is Multiple Myeloma? Symptoms, Causes, & Prognosis
https://themmrf.org/multiple-myeloma/
Being diagnosed with multiple myeloma can feel overwhelming, but myeloma can be a highly manageable disease. […] There are many paths forward from a multiple myeloma diagnosis: understanding the disease is an important first step to managing it. […] If your doctor suspects that you may have multiple myeloma, they may run several different urine and blood tests to confirm the diagnosis. […] Knowing what kind of myeloma you have is important in helping your doctor decide when it is appropriate to begin treatment. […] The presence of CRAB criteria defines active multiple myeloma. […] Individuals who are found to have slightly elevated M protein levels in their blood but do not have any symptoms and do not meet CRAB criteria may have one of two conditions that can lead to multiple myelomaâthat is, a multiple myeloma precursor condition.
#1 Multiple Myeloma Differential Diagnoses
https://emedicine.medscape.com/article/204369-differential
The most widely accepted schema for the diagnosis of multiple myeloma (MM) uses particular combinations of laboratory, imaging, and procedure findings as diagnostic criteria. The findings are as follows: […] The following combinations of findings are used to make the diagnosis of MM: […] Criteria for the diagnosis of active (symptomatic) MM are as follows: […] Historically, myeloma-defining events were designated by the acronym CRAB: hypercalcemia, renal failure, anemia, or lytic bone lesions attributable to the plasma cell disorder. […] Currently, myeloma-defining events include the following: […] Indolent MM is a subset of MM with the following features: […] Smoldering (asymptomatic) MM is similar to indolent MM. Diagnostic criteria for smoldering MM are as follows: […] The National Comprehensive Cancer Network recommends whole-body or skeletal magnetic resonance imaging (MRI), with contrast, or whole-body positron emission tomography/computed tomography (PET/CT) to differentiate active from smoldering MM.
#1 Myeloma diagnosis – Myeloma UK
https://www.myeloma.org.uk/understanding-myeloma/diagnosis/
As myeloma can thin or erode the bones, imaging tests can be important, particularly at diagnosis. A skeletal survey is a series of X-rays of the long bones, spine and the skull, to detect evidence of bone damage. More advanced imaging tests include magnetic resonance imaging (MRI) or computerised tomography (CT) scans. […] This involves taking a small sample (known as a biopsy) of the bone marrow, usually from the back of the hip bone. The sample is examined under a microscope. Normal bone marrow contains less than five per cent normal plasma cells. Myeloma patients may have between 10-90 per cent abnormal plasma cells. […] If your diagnosis is confirmed, some of these tests will be repeated regularly to monitor your myeloma over time. […] Myeloma is a very individual cancer, which can mean that the results from diagnostic tests vary from patient to patient and not all patients produce identical results.
#1 How We Diagnose Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/diagnosis
At the Jerome Lipper Multiple Myeloma Center at Dana-Farber Brigham Cancer Center, the oncologists who lead your treatment team work closely with hematopathologists to diagnose your condition and guide your treatment. These individuals have expertise in evaluating test results and genetic findings. […] The diagnostic evaluation includes a review of your medical history, a physical exam, and the tests described below. We carry out this evaluation as quickly as possible, particularly if we believe there is an urgent need for you to start treatment. […] This test is required to confirm the diagnosis of multiple myeloma. A needle is inserted into the bone marrow space to remove a small sliver of bone marrow. […] Our hematopathologists examine the tissue under a microscope to determine if there are myeloma cells in the bone marrow.
#1 Diagnosis of multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/diagnosis
Diagnosing multiple myeloma usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for multiple myeloma or other health problems. […] The following tests are commonly used to rule out or diagnose multiple myeloma. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of multiple myeloma. […] A CBC measures the number and quality of white blood cells, red blood cells and platelets. Myeloma cells (abnormal plasma cells) prevent these normal blood cells from developing in the bone marrow. A CBC is done to see if there is a shortage of these cells in the blood, which may lead to: anemia (a low red blood cell count), bleeding problems (caused by a low platelet count), weakened immune system and infections (caused by low white blood cell count).
#1
https://www.nhs.uk/conditions/multiple-myeloma/
In the early stages, myeloma may not cause any symptoms. It’s often only suspected or diagnosed after a routine blood or urine test. […] See a GP if you have any of the symptoms of multiple myeloma. While they’re unlikely to be caused by cancer, it’s best to get a proper diagnosis. […] Your GP will examine you to check for bone tenderness, bleeding, signs of infection and any other symptoms that suggest you might have myeloma. They may also arrange blood and urine tests. […] If myeloma is suspected, you’ll be referred to a consultant haematologist (a specialist in blood conditions) for further tests and treatment. […] Read more about diagnosing multiple myeloma.
#1 Myeloma diagnosis – Myeloma UK
https://www.myeloma.org.uk/understanding-myeloma/diagnosis/
We are working on projects aiming to reduce time to diagnosis and we strive to increase awareness of the early signs and symptoms of myeloma, by educating GPs and other healthcare professionals. […] Although there is currently no cure for myeloma, it is highly treatable in the majority of patients. The prognosis and life expectancy of myeloma patients has greatly improved over recent years, with an increasing number of new and effective treatment options. […] According to the most recent statistics available, just over half (50 per cent) of myeloma patients in England will live for at least five years and a third (33 per cent) will live for at least 10 years. […] There are many new drugs in the pipeline that are being tested for use at different stages of myeloma, and this means that the outlook for myeloma patients is improving all the time.
#1 Multiple Myeloma Diagnosis | Mount Sinai – New York
https://www.mountsinai.org/care/cancer/services/multiple-myeloma/what-is/diagnosis
Following diagnosis, your doctor will determine the extent of your myeloma and evaluate which multiple myeloma treatment option is best suited for you. This process is called staging. […] At the Center of Excellence for Multiple Myeloma we use these staging systems to characterize your disease and help determine the most appropriate treatment regimen.
#2
https://winshipcancer.emory.edu/cancer-types-and-treatments/multiple-myeloma/screening.php
Winship Cancer Institute of Emory Universitys experts are helping to develop multiple myeloma screening guidelines to help diagnose the cancer earlier, so you can get treated faster. […] At this time, a multiple myeloma screening process is still being developed. Early detection for multiple myeloma is difficult. […] Oftentimes, multiple myeloma is detected when a routine blood test detects a high amount of protein in the blood. This is known as an incidental diagnosis. Winships myeloma experts are working to develop efficient multiple myeloma screening options. Being able to correctly diagnose and stage multiple myeloma is essential to treatment success. […] If you have any of the above risk factors, speak with your doctor to understand whether you should have a diagnostic blood test for multiple myeloma.
#2 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0315/p373.html
Multiple myeloma accounts for 1.6% of all cancer cases and approximately 10% of hematologic malignancies in the United States. […] The diagnosis of multiple myeloma requires increased numbers of immature, abnormal, or atypical plasma cells in the bone marrow; a monoclonal protein in the serum or urine; or characteristic bone lesions. […] The diagnostic workup in a patient with suspected multiple myeloma should include a complete blood count with differential; serum chemistries; creatinine, lactate dehydrogenase, and beta2-microglobulin tests; immunoglobulin studies; skeletal survey; and bone marrow evaluation. […] In 2014, the International Myeloma Working Group revised the diagnostic criteria for multiple myeloma. These new criteria add myeloma-defining events, the presence of any one of which is sufficient to diagnose multiple myeloma.
#2 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2008/1001/p853.html
Multiple myeloma, the most common bone malignancy, is occurring with increasing frequency in older persons. […] The disease is diagnosed with serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis. […] The diagnostic criteria for smoldering (asymptomatic) multiple myeloma is a serum M protein level of 3 g per dL (30 g per L) or more, 10 percent or more bone marrow plasma cells, and no related organ or tissue impairment (i.e., no end-organ damage, including bone lesions) or symptoms. The diagnostic criteria for symptomatic multiple myeloma is M protein (serum or urine), bone marrow clonal plasma cells or plasmacytoma, and myeloma-related organ or tissue impairment. […] Patients with symptoms suggestive of multiple myeloma (e.g., unexplained weakness, fatigue, back pain, proteinuria, anemia, renal insufficiency, recurrent infections, peripheral neuropathy) should be screened with serum and urine protein electrophoresis.
#2 Multiple myeloma | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/multiple-myeloma-1?lang=us
Multiple myeloma (MM), also known by the names plasma cell myeloma and Kahler disease, is a multifocal proliferation of plasma cells based in the bone marrow. It is the most common primary malignant bone neoplasm in adults. It arises from red marrow due to the monoclonal proliferation of plasma cells and manifests in a wide range of radiographic abnormalities. Multiple myeloma remains incurable. […] International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma has following definition for multiple myeloma: clonal bone marrow plasma cells 10% or biopsy-proven bony or extramedullary plasmacytoma, and any one or more of the following myeloma defining events: evidence of end-organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically: hypercalcemia: serum calcium 0.25 mmol/L (1 mg/dL) higher than the upper limit of normal or 2.75 mmol/L (11 mg/dL), renal insufficiency: creatinine clearance 40 mL per min or serum creatinine 177 mol/L (2 mg/dL), anemia: hemoglobin value of 20 g/L below the lower limit of normal, or a hemoglobin value 100 g/L, bone lesions: one or more osteolytic lesions on skeletal radiography, CT, or PET-CT.
#2 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0315/p373.html
The classic definition of multiple myeloma required a clonal proliferation of plasma cells with evidence of end-organ damage. […] Typically, the CRAB criteria are present: calcium (hypercalcemia), renal impairment, anemia, and bone involvement (osteolytic lesions). […] In November 2014, the International Myeloma Working Group (IMWG) revised the diagnostic criteria for several reasons: imaging is now able to detect asymptomatic disease, biomarkers can better predict progression, and evidence has shown that treating asymptomatic disease is beneficial. […] These new criteria add myeloma-defining events, the presence of any one of which is sufficient for diagnosis when clonal plasma cell proliferation or plasmacytoma has been detected.
#2
https://www.orthobullets.com/pathology/8024/multiple-myeloma
Multiple Myeloma is neoplastic proliferation of plasma cells that commonly results in multiple skeletal lesions, hypercalcemia, renal insufficiency, and anemia. Patients typically present at ages 40 with localized bone pain or a pathologic fracture. […] Diagnosis is made with a bone marrow biopsy showing monoclonal plasma cells 10%. […] Diagnostic criteria include monoclonal plasma cells 10% on bone marrow biopsy or biopsy-proven bony/extramedullary plasmacytoma and 1 of the CRAB features and myeloma-defining events (MDEs). […] CRAB features of end-organ damage include hyperCalcemia, renal insufficiency, anemia, and bone lesions. […] 60% clonal plasma cells on bone marrow biopsy is one of the myeloma-defining events (MDEs). […] Serum involved:uninvolved free light chain ratio of 100 is another diagnostic criterion.
#2 Multiple Myeloma: Diagnosis
https://healthlibrary.brighamandwomens.org/HealthyKidsTeens/34,17937-1
If your healthcare provider thinks you might have multiple myeloma, certain exams and tests will be needed to be sure. Diagnosing multiple myeloma starts with your healthcare provider asking you questions. You’ll be asked about your health history, your symptoms, risk factors, and family history of disease. A physical exam will be done. […] You may have one or more of these tests: […] Blood tests […] Urine tests […] Bone marrow aspiration and biopsy […] Imaging tests […] You’ll likely have blood tests done to look for signs of multiple myeloma. These tests might include: […] Your healthcare provider will check the levels of different immunoglobulins (or antibodies) in your blood. These are proteins made by your plasma cells. In most cases, this cancer causes an increase in the level of a certain type of immunoglobulin. A test called a serum free light chain assay may also be done on your blood or urine. This test looks for certain proteins.
#2 Diagnosis of multiple myeloma | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/multiple-myeloma/diagnosis
Diagnosing multiple myeloma usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for multiple myeloma or other health problems. […] The following tests are commonly used to rule out or diagnose multiple myeloma. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment. […] A physical exam allows your doctor to look for any signs of multiple myeloma. […] A CBC measures the number and quality of white blood cells, red blood cells and platelets. Myeloma cells (abnormal plasma cells) prevent these normal blood cells from developing in the bone marrow. A CBC is done to see if there is a shortage of these cells in the blood, which may lead to: anemia (a low red blood cell count), bleeding problems (caused by a low platelet count), weakened immune system and infections (caused by low white blood cell count).
#2 How We Diagnose Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/diagnosis
Genetic studies, including metaphase cytogenetics and fluorescence in situ hybridization, are performed on the bone marrow sample to identify genetic changes that have occurred in the myeloma cells. […] You will have lab tests that include comprehensive blood chemistries, complete blood count, serum and urine protein electrophoresis, the serum free light chain assay, lactate dehydrogenase, and beta2 microglobulin. […] The serum or urine protein electrophoresis identifies the presence, type, and concentration of the M-protein, or monoclonal protein. […] The serum free light chain assay provides the concentration of the two light chains that are found in the body the kappa and lambda light chains and the ratio between these light chains. […] Staging in multiple myeloma has traditionally been done using the Durie Salmon staging system, the International Staging System (ISS), or the Revised International Staging System (R-ISS). […] It is important to note that no staging system is perfect and that patients with advanced stage disease can do very well over time with appropriate therapy. […] Our diagnostic team provides second opinions, including for challenging or difficult cases.
#2 Multiple Myeloma: Detection & Diagnosis
https://www.oregoncancer.com/multiple-myeloma/detection-diagnosis
As with most other cancers, early detection is the main key to the successful treatment of multiple myeloma. […] Doctors sometimes find multiple myeloma after a routine blood test. More often, doctors suspect multiple myeloma after an X-ray for a broken bone. […] If you have any of the above symptoms that suggest multiple myeloma, your doctor will try to find out whats causing the problem. Your doctor will first ask about your personal and family medical history. He or she will also perform a physical examination to check for signs of the disease or anything else that seems unusual. The doctor may also suggest other tests to make a diagnosis. […] Tests that may be used to diagnose multiple myeloma can include: […] Blood tests and urine tests. Myeloma cells often secrete the antibody monoclonal immunoglobulin, known as M protein. The level of M proteins helps the doctor determine the extent of the disease and monitor how effective treatment is.
#2 Tests for Multiple Myeloma | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/testing.html
If signs, symptoms, or the results of certain lab tests suggest you might have multiple myeloma, other tests will be done to find out for sure. […] If multiple myeloma is found, further tests might also be done to learn more about it and help decide the best treatments. […] Different types of lab tests can be helpful in finding multiple myeloma, learning more about it, and seeing how well treatment is working. […] Blood tests measuring levels of lactic dehydrogenase (LDH) and beta-2 microglobulin (B2M) are also often done. Levels of these substances are used to help determine the stage of the myeloma. High levels of either of these substances often means the disease is more advanced. […] Finding a monoclonal antibody in the blood is often a first step in diagnosing multiple myeloma.
#2 Multiple Myeloma: Diagnosis
https://healthlibrary.brighamandwomens.org/HealthyKidsTeens/34,17937-1
These tests can be done on blood samples to check which type of immunoglobulin the cancer cells are making and the amount. The immunoglobulin most commonly made is known as an M protein. […] This test checks the number of white and red blood cells and platelets in your blood. Myeloma cells often crowd out the normal cells in the bone marrow, which is where new blood cells are made. This can lead to low levels of normal blood cells. […] These tests check the levels of certain minerals and other chemicals in your blood. They can also give your healthcare provider an idea of how well your kidneys and liver are working. […] The immunoglobulins made by myeloma cells can often be found in urine. Your healthcare provider may ask you to collect all of your urine over a 24-hour period. They will then test it using urine protein electrophoresis (UPEP) and urine immunofixation electrophoresis (UIFE). A total protein test is also done to measure the total amount and type of protein in the 24-hour urine sample.
#2
https://www.nhs.uk/conditions/multiple-myeloma/diagnosis/
Multiple myeloma can be difficult to diagnose because it’s an uncommon type of cancer that usually has few or no symptoms in the early stages. […] If multiple myeloma is suspected, you’ll be referred to hospital to see a haematologist (a doctor who specialises in conditions affecting the blood) for further tests and scans. […] A bone marrow biopsy is usually needed to confirm multiple myeloma. […] The samples of bone marrow and bone will then be checked for cancerous plasma cells.
#2 How We Diagnose Multiple Myeloma | Dana-Farber Cancer Institute
https://www.dana-farber.org/cancer-care/types/multiple-myeloma/diagnosis
At the Jerome Lipper Multiple Myeloma Center at Dana-Farber Brigham Cancer Center, the oncologists who lead your treatment team work closely with hematopathologists to diagnose your condition and guide your treatment. These individuals have expertise in evaluating test results and genetic findings. […] The diagnostic evaluation includes a review of your medical history, a physical exam, and the tests described below. We carry out this evaluation as quickly as possible, particularly if we believe there is an urgent need for you to start treatment. […] This test is required to confirm the diagnosis of multiple myeloma. A needle is inserted into the bone marrow space to remove a small sliver of bone marrow. […] Our hematopathologists examine the tissue under a microscope to determine if there are myeloma cells in the bone marrow.
#2 Multiple Myeloma: Diagnosis
https://healthlibrary.brighamandwomens.org/HealthyKidsTeens/34,17937-1
These tests look for cancer cells in your bone marrow. […] The bone marrow samples are sent to a lab. The bone marrow, blood, and a small piece of bone are looked at under a microscope by a pathologist to check for abnormal cells. Special lab tests are also done on the samples. These can include immunohistochemistry (IHC), flow cytometry, cytogenetic analysis (karyotyping), and fluorescent in situ hybridization (FISH). These help your healthcare providers learn more about the gene and protein changes in the myeloma cells. […] Your healthcare provider may also do imaging tests to look for multiple myeloma. You may have one or more of these tests: […] Regular X-rays of your bones can be used to look for damage caused by myeloma. […] This test uses strong magnets and radio waves to create detailed images of the bone marrow and other organs. An MRI can show more detail than other imaging tests. It’s used to measure the size of the tumor.
#2 Diagnosing Multiple Myeloma | NYU Langone Health
https://nyulangone.org/conditions/multiple-myeloma/diagnosis
Our doctors use blood tests to check for high levels of abnormal proteins released into the bloodstream by multiple myeloma cells. Checking the protein levels can help determine how advanced the disease is. […] If blood test results indicate the presence of multiple myeloma, your doctor may perform a bone marrow aspiration to confirm a diagnosis. In this procedure, your doctor administers a local anesthetic and uses a small needle to withdraw liquid bone marrow from the back of the pelvis. This sample is checked under a microscope for signs of cancer and tested for gene mutations. Identifying the type of mutations in the plasma cells helps your doctor verify a diagnosis of multiple myeloma, assess how aggressive the disease is, and determine what type of treatment is best. […] Doctors may perform a skeletal survey, in which many X-rays are taken of bones throughout the body to look for lytic lesions, areas of the bone that look lighter on the X-ray than healthy bone. These are signs of bone damage from the growth of cancerous plasma cells. This test can help determine where in the body the disease may be located.
#2 Multiple Myeloma | Diagnosis of Multiple Myeloma | LLS
https://www.lls.org/myeloma/diagnosis
Bone Marrow Tests: Your doctor tests your bone marrow to look for malignant plasma cells. Bone marrow testing involves two steps usually done at the same time in a doctor’s office or a hospital: […] Fluorescence In Situ Hybridization (FISH): FISH is a laboratory test to see if there are changes to the chromosomes of the myeloma cells taken from the bone marrow. […] Next-Generation Sequencing (NGS): This test looks for mutations in the genes of the myeloma cells. […] Imaging Tests: Bone problems are common in people with myeloma. Imaging tests make images (pictures) of the inside of the body and can help show bone problems such as bone lesions, breaks or thinning of the bones. […] A myeloma diagnosis requires both of the following criteria: […] In addition, doctors stage myeloma to help them decide on the best treatment plan.
#2 Myeloma tests | Blood Cancer UK
https://bloodcancer.org.uk/understanding-blood-cancer/myeloma/symptoms-diagnosis/myeloma-tests-diagnosis/
Knowing which genes are affected helps doctors give a specific diagnosis, get more information about how the myeloma might develop, and in some cases, decide which treatment is likely to work best. […] These results of these tests give more information about the status of the myeloma now and what’s likely to happen in the future (your prognosis). […] If the level is higher than normal, it’s a sign of cell and tissue damage. This gives more information about your prognosis. […] After you have been diagnosed, you may need regular tests to monitor the myeloma. This will happen if you don’t need treatment yet, and also if you are having check-ups after treatment.
#2 Multiple Myeloma Diagnosis: Tests, Scans and Biopsies
https://www.cancercenter.com/cancer-types/multiple-myeloma/diagnosis-and-detection
A flow cytometry test for multiple myeloma may provide valuable insight into whether the tumor cells contain a normal or abnormal amount of DNA, and the relative rate at which the tumor is growing. […] After performing a variety of tests and examining the patient, the care team will determine whether the patient has multiple myeloma. Diagnosing myeloma typically requires: […] A plasma cell tumor confirmed via biopsy or a minimum of 10 percent plasma cells were found in the bone marrow, and […] A least one of these markers: […] A low red blood cell count (anemia) […] Inadequate kidney function […] High levels of blood calcium […] A least 60 percent plasma cells in the bone marrow […] Holes in the bones due to tumors […] Elevated light chain in the blood.
#2 Tests for Multiple Myeloma | MyMyelomaTeam
https://www.mymyelomateam.com/resources/lab-tests-for-multiple-myeloma-what-you-need-to-know
Serum protein electrophoresis (SPEP) is another antibody test. Myeloma antibodies are all the same (monoclonal). SPEP measures all of the antibodies in the blood and determines which are monoclonal. […] An immunofixation or immunoelectrophoresis test determines exactly what type of abnormal antibodies are present in the blood. […] A serum free light chain test looks at chains formed by immunoglobulins. […] This test looks for the presence of the protein beta-2 microglobulin. High levels of this protein are an indicator of disease progression. […] Imaging tests for myeloma include X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, and positron emission tomography (PET) scans. […] Bone marrow biopsy is an important step in diagnosing multiple myeloma. […] If myeloma cells are present, the pathologist moves on to the next important assessment, genome sequencing. […] Genome sequencing can be used to determine what kind of multiple myeloma a person has.
#2 Multiple Myeloma: Diagnosis and Treatment | AAFP
https://www.aafp.org/pubs/afp/issues/2008/1001/p853.html
Serum and urine protein immunofixation are also recommended because immunofixation can be diagnostic even with a normal or nonspecific protein electrophoretic pattern. […] Bone marrow aspirate analysis should be performed in patients with abnormal serum or urine proteins and may require multiple samples because findings may be focal. […] Most patients with symptomatic multiple myeloma have increased M protein levels (more than 3 g per dL) on serum protein electrophoresis. […] The type and amount of urine monoclonal light chains are typically measured with urine protein immunofixation. […] There is no standard imaging work-up for multiple myeloma, but a skeletal radiograph survey is generally recommended. […] Magnetic resonance imaging (MRI) is the preferred technique for suspected spinal compression or soft-tissue plasmacytomas. […] Several additional biochemical and genetic markers have been shown to correlate with prognosis in patients with multiple myeloma, but they should not be used for diagnosis.
#2 The Diagnosis and Treatment of Multiple Myeloma
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973001/
Multiple myeloma is a malignant disease of plasma cells with a worldwide incidence of 67 cases per 100 000 persons per year. It is among the 20 most common types of cancer in Germany. […] The diagnostic evaluation of multiple myeloma comprises thorough history-taking and physical examination, various laboratory tests including analysis of a 24-hour urine sample, a bone-marrow biopsy, and skeletal radiography. […] The indication for initiation of treatment for multiple myeloma is essentially determined according to the CRAB criteria. […] The diagnostic work-up comprises mandatory analysis of blood and urine samples, bone marrow evaluation, and imaging procedures. […] For reasons of sensitivity, the conventional whole-body radiographic bone survey (the so-called Paris scheme) has largely been abandoned in favor of low-dose whole-body computed tomography.
#2 Multiple Myeloma: Diagnosis
https://healthlibrary.brighamandwomens.org/HealthyKidsTeens/34,17937-1
A CT scan uses X-rays taken from many angles to create very detailed cross-sectional pictures of organs and shows abnormalities or tumors in soft tissues. […] For this test, a radioactive sugar is put into your blood. It tends to collect in cancer cells. A special camera is then used to see which parts of your body have taken up more of the sugar. The picture from a PET scan is not very detailed, but it can show likely areas of cancer all over your body. Many machines can now do both a PET scan and CT scan at the same time. This is known as a PET/CT scan. […] Your healthcare provider will talk with you about other tests you may need if multiple myeloma is found. Make sure you understand the results and what follow-up you need.
#2 What is Multiple Myeloma? Symptoms, Causes, & Prognosis
https://themmrf.org/multiple-myeloma/
Diagnosis usually only happens incidentally, such as when a doctor investigating another health issue happens to discover M protein in the blood or urine. […] Multiple myeloma, a cancer of the plasma cells, is part of a disease spectrum; it is the last stage of a process that generally begins with MGUS and progresses to SMM before advancing to myeloma. […] Active multiple myeloma is differentiated from the precursor conditions based on the presence of myeloma-defining events or one or more CRAB criteria. […] Research has greatly improved the prognosis or predicted course of the disease for multiple myeloma patients. […] Determining the stage of your disease is one of the most significant factors in developing a personalized treatment plan. […] The most commonly used staging system is the Revised-International Staging System (R-ISS), which is based on the results of FISH testing of the bone marrow and three blood tests: lactate dehydrogenase (LDH), beta-2 microglobulin (2M), and albumin.
#2 How Multiple Myeloma Is Diagnosed
https://www.everydayhealth.com/multiple-myeloma/diagnosis/
Physicians sometimes diagnose a condition called monoclonal gammopathy of unknown significance, or MGUS, after blood samples taken during a routine medical checkup reveal unusually high levels of protein. […] For people with MGUS, abnormal plasma cells make up less than 10 percent of the cells in bone marrow.
#2 Myeloma diagnosis – Myeloma UK
https://www.myeloma.org.uk/understanding-myeloma/diagnosis/
As myeloma can thin or erode the bones, imaging tests can be important, particularly at diagnosis. A skeletal survey is a series of X-rays of the long bones, spine and the skull, to detect evidence of bone damage. More advanced imaging tests include magnetic resonance imaging (MRI) or computerised tomography (CT) scans. […] This involves taking a small sample (known as a biopsy) of the bone marrow, usually from the back of the hip bone. The sample is examined under a microscope. Normal bone marrow contains less than five per cent normal plasma cells. Myeloma patients may have between 10-90 per cent abnormal plasma cells. […] If your diagnosis is confirmed, some of these tests will be repeated regularly to monitor your myeloma over time. […] Myeloma is a very individual cancer, which can mean that the results from diagnostic tests vary from patient to patient and not all patients produce identical results.
#2 Multiple Myeloma Differential Diagnoses
https://emedicine.medscape.com/article/204369-differential
Amyloidosis is often secondary to MM, but it may develop without MM. Patients with amyloidosis typically lack sufficient numbers of plasma cells in the bone marrow or sufficiently high levels of M protein to meet the diagnostic criteria for MM. […] Solitary plasmacytoma may occur in bone or soft tissue. Osseous plasmacytoma is a localized bone tumor of plasma cells, without evidence of plasma cell myeloma or marrow plasmacytosis; the most common site is the vertebrae. Extraosseous solitary plasmacytoma is a localized soft-tissue plasma cell neoplasm that occurs in a location other than the bone and does not have evidence of plasma cell myeloma or marrow plasmacytosis.
#2 Myeloma tests | Blood Cancer UK
https://bloodcancer.org.uk/understanding-blood-cancer/myeloma/symptoms-diagnosis/myeloma-tests-diagnosis/
If you go on to get a diagnosis of myeloma and have treatment for it, you will have regular FBCs to help check how well the treatment is working. […] If doctors suspect you have myeloma after the screening tests, they will do more tests to confirm the diagnosis and find out more. These tests will also help doctors decide when and how to treat you. […] To confirm your diagnosis and investigate further, doctors will need to take samples of your bone marrow. This procedure is called a bone marrow biopsy. […] Your bone marrow samples will be studied under a microscope to see if there are any myeloma cells, how many there are, and find out more about the genetic changes in these cells. […] If you have non-secretory myeloma, a type of myeloma where there are no paraproteins in the blood, scans are essential to show the progress of the myeloma and make decisions about treatment.
#2 Can Multiple Myeloma Be Found Early? | American Cancer Society
https://www.cancer.org/cancer/types/multiple-myeloma/detection-diagnosis-staging/detection.html
It can be hard to diagnose multiple myeloma early, and there are no recommended screening tests to look for it in most people. […] Often, multiple myeloma causes no symptoms until it reaches an advanced stage. Sometimes, it causes vague symptoms that might at first seem to be caused by other diseases. […] Multiple myeloma is sometimes found early when a routine blood test shows a high amount of protein in the blood, but there are no recommended screening tests to look for multiple myeloma in most people. […] Because people with these conditions are at higher risk of multiple myeloma, doctors usually do regular bloodwork to watch for early signs. This might lead to multiple myeloma being diagnosed earlier in people with MGUS or a solitary plasmacytoma. […] For more on how multiple myeloma is diagnosed, see Tests for Multiple Myeloma.
#2 The Diagnosis and Treatment of Multiple Myeloma
https://pmc.ncbi.nlm.nih.gov/articles/PMC4973001/
Box 2 summarizes the investigations that are necessary for initial diagnosis of multiple myeloma. […] The symptoms reported by patients with multiple myeloma on presentation are often non-specific and may already have been present for an extended period. Anemia of unknown origin is found in 73% of patients, bone pain in 58%, and fatigue in 32%. […] The treatment of recurrent/refractory (r/r) multiple myeloma depends on age, comorbidities, and previous treatment. […] The best time to begin treatment is keenly debated. If paraprotein is increasing slowly, initiation of treatment can be delayed, but therapy should be initiated immediately in the presence of new myeloma-related organ damage and/or a rapid increase in paraprotein. […] The proteasome inhibitor bortezomib is among the substances most frequently used in patients with r/r multiple myeloma.
#2 Diagnostic Testing for Multiple Myeloma | Blood, Urine, & Bone Tests
https://themmrf.org/diagnosis-and-treatment/diagnostic-testing/
A level of myeloma cells in the bone marrow that exceeds 10% confirms a diagnosis of multiple myeloma; a higher percentage indicates more extensive disease. […] It is strongly recommended that multiple myeloma patients undergo genomic sequencing when possible. Genome sequencing can provide valuable information about your prognosis, your treatment options, and how your myeloma is changing in response to treatment. […] Along with blood and urine tests, imaging tests can provide valuable information about the status of your myeloma. Imaging tests conducted on bone help the healthcare team diagnose multiple myeloma and are used to monitor the disease during treatment.