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Diagnosis and Prognosis of Multiple Myeloma
Testing for Multiple Myeloma
- Complete blood count—Measures the number of red blood cells, white blood cells, and platelets. Low numbers of healthy blood cells or high numbers of plasma cells may indicate the presence of multiple myeloma.
- Blood smear—Examines a drop of blood under a microscope to look for abnormalities of the blood cells. Abnormalities include cell counts and genetic markers that may be present or missing.
- Immunoglobulin—Measures the amount of specific blood proteins to look for signs of multiple myeloma. Some proteins may be present or missing.
- Erythrocyte sedimentation rate (ESR)—To detect or measure inflammation.
- A check of blood calcium levels to see if it is elevated or high.
- An evaluation of kidney function.
Diagnosis of Multiple Myeloma
- A plasma cell tumor is confirmed by the bone marrow biopsy OR the presence of 10% or more of plasma cells in the bone marrow WITH one or more of the following:
- The presence of plasma cells in the bone marrow (60% or higher)
Staging of Multiple Myeloma
- Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
- Flow cytometry and cell marker tests to examine cells for specific characteristics, like proteins.
- Tests to evaluate changes or damage to cellular DNA.
- Imaging tests may be used to evaluate the extent of cancer and involved organs. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may depend on suspected location of cancer based on symptoms, but may include:
Tissue biopsies are done to confirm the presence of cancer in specific locations. It may also be used to look for abnormally-shaped proteins that are stuck together (amyloids). Amyloids can deposit and build up in any bodily tissue, including the heart or kidneys, and cause problems. Biopsies are done with a:
- Fine needle—A thin needle is inserted into a tumor, lymph node, or other tissue. Both tissue and fluid are removed.
- Core needle—A larger, hollow needle is used in the same manner. It allows for the removal of a larger sample.
- Blood or urine level of abnormal proteins produced by the cancer cells.
- Blood level of calcium—High levels are linked to bone damage caused by cancer cell growth in the bone marrow. Calcium is released into the blood when bone tissue is damaged.
- X-ray evidence—Myeloma may be evident on an x-ray based on the appearance of specific bone damage.
- Blood hemoglobin level—Hemoglobin is an iron-containing protein in red blood cells that carries oxygen to the cells. The presence of cancer cells in the bone marrow may interfere with red blood cell production and cause anemia.
Stage I—A small number of cancer cells are found with ALL of the following:
- Small amounts of abnormal proteins are present in the blood or urine.
- Calcium in the blood falls into a normal range (less than 12 milligrams per deciliter [mg/dL])
- X-ray appears normal OR may show one area of bone damage
- Hemoglobin level is more than 10.5 g/dL (grams per deciliter)
- Stage II—A moderate amount of cancer cells are found. Other factors fall in a range BETWEEN Stage I and Stage III.
Stage III—A large number of cancer cells are found with ONE or MORE of the following:
- Large amounts of abnormal proteins are present in the blood or urine.
- Calcium levels fall into a high range (more than 12 mg/dL)
- X-rays show 3 or more areas of bone damage.
- Hemoglobin levels fall into a low range (less than 8.5 g/dL)
- Stage I—Beta-2 microglobulin is less than 3.5 mg/L (milligrams per liter) and albumin is 3.5 g/dL or higher
- Stage II—Beta-2 microglobulin is 3.5-5.5 mg/L with any albumin level OR albumin is less than 3.5 g/dL with beta-2 microglobulin less than 3.5 mg/L
- Stage III—Beta-2 microglobulin is more than 5.5 mg/L.
- Smoldering—Disease is present, but it progresses slowly without symptoms.
- Symptomatic—Disease is present and causing associated symptoms, such as bone or kidney disease, or is affecting healthy blood cell counts.
- Reviewer: Mohei Abouzied, MD, FACP
- Review Date: 03/2017
- Update Date: 05/12/2016