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How We Diagnose Multiple Myeloma

  • Multiple Myeloma: Diagnosis and Risk Assessment
    Nikhil C. Munshi, MD, Director of Basic and Correlative Science at the Jerome Lipper Multiple Myeloma Cancer and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer Institute and Professor of Medicine at Harvard Medical School, discusses diagnosis and risk assessment in multiple myeloma.

  • At the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), the oncologists who lead your treatment team work closely with hematopathologists to diagnose your condition and guide your treatment. These individuals have expertise in evaluating test results and genetic findings.

    The diagnostic evaluation includes a review of your medical history, a physical exam, and the tests described below. We carry out this evaluation as quickly as possible, particularly if we believe there is an urgent need for you to start treatment.

    Bone marrow biopsy

    • This test is required to confirm the diagnosis of multiple myeloma. A needle is inserted into the bone marrow space to remove a small sliver of bone marrow.
    • Our hematopathologists examine the tissue under a microscope to determine if there are myeloma cells in the bone marrow.
    • Genetic studies, including metaphase cytogenetics and fluorescence in situ hybridization, are performed on the bone marrow sample to identify gene changes that have occurred in the myeloma cells. We have the capacity to perform more specialized assessments of gene changes as well, and can discuss these with you at the time of your visit.
    • Bone marrow biopsies are also performed intermittently after the initial diagnostic study, although we try to limit how often they are done.

    Blood tests

    You will have lab tests that include comprehensive blood chemistries, complete blood count, serum and urine protein electrophoresis, the serum free light chain assay, and beta2 microglobulin. These tests allow us to evaluate the function of organs, such as the kidney, liver, and bone marrow, and to assess the status of your multiple myeloma at regular intervals.

    The serum or urine protein electrophoresis identifies the presence, type, and concentration of the M-protein, or monoclonal protein. It also provides a measure of the concentration of the major immunoglobulin types in the blood, including IgG, IgA, and IgM.

    The serum free light chain assay provides the concentration of the two light chains that are found in the body — the kappa and lambda light chains — and the ratio between these light chains. People with multiple myeloma typically have abnormally high levels of either kappa or lambda light chain, and an abnormal ratio between the two light chains.

    Radiographic studies

    You will have imaging studies to evaluate for bone or other abnormalities. These studies could include X-rays, MRI, CT, and/or PET-CT imaging.

    Staging

    Staging in multiple myeloma has traditionally been done using the Durie Salmon staging system and the International Staging system. The Durie Salmon staging system provides insight regarding the overall amount of disease at time of diagnosis, while the International Staging System, which is based on the concentration of albumin and beta2 microglobulin at time of initial diagnosis, provides insight on prognosis.

    It is important to note that no staging system is perfect and that patients with advanced stage disease can do very well over time with appropriate therapy.