Diagnosis of Multiple Myeloma

The following tests and procedures may be used to diagnose multiple myeloma and other plasma cell neoplasms:
  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Biopsy: The removal of bone cells, lymph nodes, or tissues so they can be viewed under a microscope by a pathologist to check for abnormal cells or signs of cancer.
  • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
  • X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. The x-rays are used to find areas where the bone is damaged.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI may be used to find areas where the bone is damaged.
  • Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells and platelets.
    • The number and type of white blood cells.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells. o The portion of the blood sample made up of red blood cells.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as calcium or albumin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Blood or urine immunoglobulin studies: A procedure in which a blood or urine sample is checked to measure the amounts of certain antibodies (immunoglobulins). For multiple myeloma, beta-2-microglobulin, M protein, and other proteins made by the myeloma cells are measured. A higher-than-normal amount of these substances can be a sign of disease.
  • Twenty-four-hour urine test: A test in which urine is collected for 24 hours to measure the amounts of certain substances. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. A higher than normal amount of protein may be a sign of multiple myeloma.
  • Electrophoresis: A test in which a blood or urine sample is checked for M proteins and the amount of M proteins is measured.
  • Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes.
Factors Affecting Prognosis and Treatment Options The prognosis (chance of recovery) depends on the following:
  • The type of plasma cell neoplasm.
  • The stage of the disease.
  • Whether a certain immunoglobulin (antibody) is present.
  • Whether there are certain genetic changes.
  • Whether the kidney is damaged.
  • Whether the cancer responds to initial treatment or recurs (comes back).
Treatment options depend on the following:
  • The type of plasma cell neoplasm.
  • The age and general health of the patient.
  • Whether there are health problems related to the disease.
  • Whether the cancer responds to initial treatment or recurs (comes back).
 

Stages of Multiple Myeloma and Other Plasma Cell Neoplasms

The process used to find out the amount of cancer in the body is called staging. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
  • X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body such as the bone marrow. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Bone densitometry: A procedure that uses a special type of x-ray to measure bone loss. Certain tests may be repeated to see how well the treatment is working.
The stage of multiple myeloma is based on the levels of beta-2-microglobulin and albumin in the blood. Beta-2-microglobulin and albumin are found in the blood. Beta-2-microglobulin is a protein found on the surface of plasma cells. Albumin makes up the biggest part of the blood plasma. It keeps fluid from leaking out of blood vessels, brings nutrients to tissues, and carries hormones, vitamins, drugs, and other substances, such as calcium, throughout the body. The amount of beta-2-microglobulin is increased and the amount of albumin is decreased in the blood of patients with multiple myeloma. The following stages are used for multiple myeloma:

Stage I multiple myeloma

In stage I multiple myeloma, the blood levels are as follows:
  • beta-2-microglobulin level is lower than 3.5 g/mL; and
  • albumin level is 3.5 g/dL or higher.

Stage II multiple myeloma

In stage II multiple myeloma, the blood levels are as follows:
  • beta-2-microglobulin level is lower than 3.5 g/mL and the albumin level is lower than 3.5 g/dL; or
  • beta-2-microglobulin level is as high as 3.5 g/mL but lower than 5.5 g/mL.

Stage III multiple myeloma

In stage III multiple myeloma, the blood level of beta-2-microglobulin is 5.5 g/mL or higher. The stages of other plasma cell neoplasms are different from the stages of multiple myeloma. Isolated plasmacytoma of bone In isolated plasmacytoma of bone, one plasma cell tumor is found in the bone, less than 5% of the bone marrow is made up of plasma cells, and there are no other signs of cancer. Extramedullary plasmacytoma One plasma cell tumor is found in the soft tissue but not in the bone or the bone marrow. Macroglobulinemia There is no standard staging system for macroglobulinemia. Monoclonal Gammopathy of Undetermined Significance In monoclonal gammopathy of undetermined significance (MGUS), less than 10% of the bone marrow is made up of plasma cells, there is M protein in the blood, and there are no signs of cancer.

Refractory Multiple Myeloma and Other Plasma Cell Neoplasms

Multiple myeloma and other plasma cell neoplasms are called refractory when the number of plasma cells continues to increase even though treatment is given.