BETA - What are beta 2 microglobulin, LDH and albumin? Why are the tested at diagnosis? How often should they be tested?

When someone is diagnosed with myeloma, a few key blood tests can reveal a lot about what's happening inside the body. Beta-2 microglobulin, LDH, and albumin. But what do these names actually mean, and why are they so important at diagnosis? In this Health Tree University lesson, we'll break down what each of these markers tells us, why they matter in myeloma, and how often they should be checked to help guide treatment and track progress. What are beta-2 microglobulin, LDH, and albumin? Why are they tested at myeloma diagnosis? There are a lot of blood tests that we get from myeloma, and I think that's one of the most anxiety-inducing aspects of the disease is we're constantly drawing blood. So you leave your visit with your doctor or nurse practitioner, you get home and you get a buzz that your portal has a new result of the blood test, and it has a range, and what does it mean? So beta-2 microglobulin and albumin are two of the blood tests that we use as part of the international staging system for myeloma. And the best way to think of beta-2 microglobulin is it's found on all the cancer cells. So more beta-2 microglobulin typically means more myeloma, less means a lower amount of the disease, but we have to remember that that chemical is cleared out of the body by the kidneys. So if you have some kidney abnormalities, you may make a normal amount but not pee it out so the levels build up in the blood. Albumin is like the white of an egg, and for lack of a better term, it's a general function of health. High albumin is good and low albumin is bad. So when it comes to the international staging system for myeloma, which has three stages, stage one is a high albumin and a low beta-2 microglobulin. Stage three is a high beta-2 microglobulin and stage two is anywhere in the middle. But around 2015, we said, well, we know more about cancer and let's see if we can update this to make this a better prognostic model. And that's where we included two things, cytogenetics, classifying people as high risk or standard risk. We also added LDH. LDH stands for lactate dehydrogenase, and know this has nothing to do with your cholesterol. But LDH is made in almost every cell in the human body. And the higher levels of LDH means you're having more cell turnover, more DNA replication, more cells dividing and growing. So we actually took a page out of the lymphoma textbook, whereas high LDH usually means a more aggressive disease because it's trying to grow faster. And that's a predictor in the revised ISS system of higher stage disease. Are these markers retested periodically or only at diagnosis to help with staging? Beta-2 microglobulin is really not used in regular testing. So outside of the initial staging, we don't need to recheck beta-2 microglobulin. Albumin is typically included on a lot of our regular comprehensive metabolic panels. And it can be a good marker. It's something that you may see drop initially when you get treated or after transplant. And as you recover, that level will go up. It's also important to look for albumin because people that have a connected disease called AL amyloidosis of the kidney can have low albumin levels because they pee out albumin in the form of bubbles. LDH can go up and down for a lot of reasons. It can go up, unfortunately, when myeloma recurs. It can also go up when you have infections. And even more crazy, if when they draw your blood, the needle goes in at a sharp angle vein, the needle shreds or breaks open the red cells, there's LDH inside of red blood cells. So you sometimes may see on your lab report the word hemolyzed. It just means that needle broke apart, hemolyzed, killed the red blood cells, and it dumped its LDH into the blood. And that level, along with things like potassium, may go up higher. So we check albumin and LDH on a regular basis. They don't always indicate a specific event, but them going up or down may have some meaning in part of the total care. Are they part of the comprehensive metabolic panel? So the albumin is usually included in a comprehensive metabolic panel. The LDH sometimes is, sometimes is not. It really depends upon the lab. How common is it to have high levels of LDH? What do high levels of LDH indicate? LDH is increased in multiple myeloma, fairly infrequently. And when you see high LDH in myeloma, it usually indicates an aggressive myeloma. And this is one indication in our center, if you see a patient with high LDH, to do a PET CT scan, because those patients sometimes do present with what's called exosomalodonic plasma cytoma or exosomalodonic disease. And those patients can also have plasma cell leukemia. So high LDH pushes us to do PET scan and flow cytometry in the peripheral blood. What do elevated levels of beta-2 microglobulin indicate? Beta-2 microglobulin is a protein that's secreted by the plasma cells, but it's very nonspecific, meaning patients that have kidney problems will have very high levels of beta-2 microglobulin. So it's a reflection on both the myeloma tumor load as well as the kidney function. What do low levels of albumin indicate? Albumin is a little bit confusing because albumin is another protein, but it's the most common protein in the body. It's manufactured by the liver. And in myeloma, you can have low albumin, which is a bad marker or poor prognostic marker. And that can be related to inhibition of the manufacturing of the albumin in the liver. There is a cytokine or a substance secreted by the myeloma cells called interleukin 6. And we know that interleukin 6 can inhibit albumin production in the liver. And we also know that albumin can be secreted in the kidney. So whether it's a production issue or ability to maintain the albumin in the serum can be an issue for patients. Albumin has always been used in monitoring patients. LDH is also used in monitoring patients. So if the LDH is high and it comes down as treatment, that's a good issue. Beta-2 microglobulin is less reliable in monitoring response to treatment. LDH, albumin, and beta-2 microglobulin are key biomarkers used in staging multiple myeloma, which helps predict prognosis and guide treatment decisions. We learned that beta-2 microglobulin reflects tumor burden and kidney function. Higher levels of beta-2 microglobulin predicts a worse prognosis. Albumin indicates overall health and inflammation. Lower levels are associated with a worse prognosis. And LDH, lactate dehydrogenases, is a marker of aggressive disease and high cell turnover. Elevated LDH indicates poorer outcomes. 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