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Diagnosis and Prognosis of Multiple Myeloma

In some people, a problem is found during a routine blood or urine test. Others may see their doctor when symptoms appear. The most common are bone pain, or feeling weak or tired. The doctor may think there is a blood disorder based on a physical exam, symptoms, and health past.

Testing for Multiple Myeloma

If your doctor thinks you have a blood disorder, tests will help find a cause. These may include:

Blood and Urine Tests

Blood tests will show changes in blood cells. Tests may include:

  • Complete blood count—To see if blood cells are in a normal range.
  • Blood smear—A drop of blood is looked at in a lab. It can show the number of each type of blood cell and how many abnormal cells are in the blood.
  • Tests to look for certain proteins that may be present or missing.
  • Tests to check how thick the blood is.
  • Tests to check calcium levels.
  • Tests to see if the kidneys are working as they should.
  • Erythrocyte sedimentation rate (ESR)—To detect or measure inflammation.

Urine tests may also help identify abnormal levels of certain proteins or calcium levels.

 

Bone Marrow Aspiration and Biopsy

A bone marrow aspiration takes a sample of bone marrow through a needle. It is often taken from the hip bone. A piece of bone may also be removed for biopsy. The samples are looked at in a lab. The tests will check on blood cells counts and the overall health of the bone marrow.

 

Skeletal Survey

A series of x-rays of all the body's bones will check for broken bones or other problems such as holes in the bones. The skull, spine, pelvic area, ribs, and the long bones of the arms and legs are tested.

Diagnosis of Multiple Myeloma

MM diagnosis is based on the results of different tests that may show:

  • Plasma cell tumors
  • Holes in the bones or other problems
  • Too many or abnormal plasma cells in the bone marrow
  • Low blood cell counts or abnormal blood cells in the blood or bone marrow
  • Kidney problems
  • Too much calcium in the blood
  • Abnormal levels of certain proteins that can lead to amyloid deposits (abnormally shaped proteins that stick together and buildup in the body)

Staging of Multiple Myeloma

Results from tests above along with new tests will show details about MM. This will help make a treatment plan.

Staging Tests

Blood and tissue tests are used to find out how much cancer is in the body.

Imaging tests check organs and tissues for cancer. They can also see the extent of bone problems. Tests may involve a CT scan or MRI scan.

Biopsies look for cancer or amyloid deposits in certain places. Biopsies can be:

  • Fine needle—A thin needle is inserted to remove tissue or fluid.
  • Core needle—A larger, hollow needle is used in the same manner so more tissue or fluid can be taken.

Stages of Multiple Myeloma

MM is staged from 1 to 3. Stage 1 is linked to the least amount of cancer, while stage 3 is linked to the most.

There are different staging systems. The stage is mainly based on the amount of:

  • Abnormal proteins in the blood or urine that is being made by the cancer cells.
  • Calcium in the blood.
  • Bone damage.
  • An iron-containing protein in the blood called hemoglobin. Hemoglobin carries oxygen to the body's cells.
  • A protein that causes amyloids to buildup in the body.
  • A protein in the blood linked to kidney problems.

For treatment purposes, MM may also be grouped as:

  • Smoldering—Disease is present, but it progresses slowly without symptoms.
  • Symptomatic—Disease is present and causing symptoms such as bone or kidney disease, or is affecting healthy blood cell counts.
REFERENCES:

Diagnosis. Leukemia & Lymphoma Society website. Available at: https://www.lls.org/disease-information/myeloma/diagnosis. Accessed May 6, 2019.

Michels TC, Petersen KE. Multiple myeloma: Diagnosis and treatment. Am Fam Physician. 2017;95(6):373-383A.

Multiple myeloma. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116888/Multiple-myeloma. Updated March 29, 2019. Accessed May 6, 2019.

Multiple myeloma stages. American Cancer Society website. Available at: https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/staging.html. Updated February 28, 2018. Accessed May 6, 2019.

Myeloma staging. Leukemia & Lymphoma Society website. Available at: https://www.lls.org/disease-information/myeloma/diagnosis/myeloma-staging. Accessed May 6, 2019.

Stages of plasma cell neoplasms. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloma/patient/myeloma-treatment-pdq#_22. Updated April 9, 2019. Accessed May 6, 2019.

Tests to find multiple myeloma. American Cancer Society website. Available at: https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/testing.html. Updated February 28, 2018. Accessed May 6, 2019.

Last reviewed March 2019 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 5/6/2019