What testing should be done at diagnosis?
So, to confirm a myeloma diagnosis, we need to do a battery of tests. These include blood tests, urine tests, tests on the bone marrow, and also imaging tests. These give us a variety of information, both to help diagnose the disease and to establish the aggressiveness of the disease. It also has implications for what treatments we decide to give our patients.
As far as the blood tests go, we do a complete blood count, looking mainly for the hemoglobin level. We do a chemistry test to look at the kidney function, also to look at the albumin level and the patient's blood and also the calcium level. We do a variety of other tests that are more for prognostic purposes, including a beta 2 microglobulin and a lactate dehydrogenase test.
Suffice to say, there's a battery of tests that are done for screening. For more specific diagnosis, we look for the cancer protein, employing a variety of methods to do so. One is serum protein electrophoresis. Another is quantitative immunoglobulins. Then there’s the serum free light chain assay.
As regards the tests in the urine, we're initially trying to see if there is protein spilling into the urine and what kind of protein it is. We ask for a 24-hour urine collection to be done on patients. Regarding the bone marrow biopsy, we do a variety of tests in the bone marrow. One is to look at the number of plasma cells, which are the cell type that gives rise to this cancer in the bone marrow. Normally, these should be less than 5% of the cells. In this condition, we see that patients have more than 5%, often with the majority of their cells in the bone marrow being plasma cells.
In addition to looking at the cells under the microscope, we send that cell for chromosomal analysis and FISH testing, which gives us prognostic information and also informs our decision on how to treat patients. Imaging plays an important role in the diagnosis and staging of myeloma. In previous years, a skeletal survey using X-rays was the main imaging tool for the detection of lytic bone lesions in patients with myeloma. However, the International Myeloma Working Group now recommends whole body PET CT, low dose whole body CT, or MRI of the whole body or spine, depending on the availability of each imaging modality in the clinical setting.
Imaging tests have historically included X-rays of all bones in the body. This remains part of our testing, but increasingly, we are using PET CT scans and MRI scans of the spine and pelvis in several patients, depending on their presentation.
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HealthTree • March 10, 2025