Updated 22 Feb. 2012
Required tests:
- Serum and urine protein studies as described in Appendix II
- serum protein electrophoresis (SPE)
- serum protein immunofixation
- quantitative immunoglobulins
- serum free light chain levels (should be done if the SPEP does not demonstrate a monoclonal protein and suspicion for myeloma is high)
- urine protein 24 hour quantitation and electrophoresis
- Serum calcium, uric acid, creatinine
- beta-2-microglobulin (required at diagnosis for staging only and should not be repeated as a marker of disease response)
- CBC
- Chest radiograph
- Skeletal radiographic survey (skull, spine, humeri, pelvis, femora, ribs)
- Urgent MRI or CT of the spine should be considered for patient with back pain and spinal cord compression is suspected
- Bone marrow aspiration and biopsy, with:
- FISH probe for translocation t(4;14)
- FISH probe for translocation t(14;16)
- FISH probe for chromosome 17p deletion
- Hepatitis BAg, hepatitis BAb, hepatitis C Ab
Note: Bone scanning is seldom useful in myeloma. Intravenous radiographic contrast studies must be used with caution because they may cause renal injury.
The diagnostic criteria of myeloma have recently been modified by the International Myeloma Working Group (Anonymous B J Hematology 2003;121:749-757). All three of the following must be present:
- Monoclonal paraprotein
- Bone marrow plasmacytosis or biopsy proven plasmacy
- toma
- At least one end organ consequence not due to another detectable cause (note mnemonic CRAB)
- HyperCalcemia
-
Renal failure
-
Anemia
- Lytic Bone lesions
The following additional finding can be helpful supportive evidence for the diagnosis of myeloma if present:
-
depression of the levels of the uninvolved immunoglobulins
Remember that 2-5% of myeloma patients have no abnormal protein detectable in urine or serum, so-called non-secretory myeloma. Such cases should be accepted as myeloma only if criteria 2 and 3 above are present plus lytic bone lesions or two of the CRAB criteria. For such patients a serum free light chain level test should be requested as a significant number of these patients will have abnormal values.
