Tests & Diagnosis

With its many subtypes and stages, accurately diagnosing multiple myeloma is critical to determining the right treatment. To provide you with every advantage, our team of multiple myeloma experts uses the most advanced equipment and techniques available. Banner MD Anderson Cancer Center is one of only a few cancer centers performing genetic testing on bone marrow to determine exactly which therapies will work best for you. This ensures you get the most effective multiple myeloma treatment with the least impact on your body. 

Early diagnosis of multiple myeloma is important to successful treatment outcomes. The longer you wait, the more abnormal plasma cells are created. If left untreated, these cells cause irreversible damage to your bones, blood, kidneys and immune system. 

Is There a Screening Test for Multiple Myeloma?

No screening test exists for multiple myeloma and it’s difficult to diagnose early because it may not cause symptoms {link to 17.2 Multiple Myeloma_Symptoms and Types} until reaching more advanced stages.  Sometimes, multiple myeloma is found during routine wellness testing. 

Patients with MGUS (monoclonal gammopathy of unknown significance) or solitary plasmacytoma should have routine bloodwork to monitor for signs of multiple myeloma.

What Tests Are Used to Diagnose Multiple Myeloma?

After confirming symptoms of multiple myeloma, your doctor will do a full physical exam and get information about your health and medical history. One or more of the following tests may be used to find out if you have multiple myeloma, if it has spread and monitor how treatment is working.

• Urine tests: Tests called urine protein electrophoresis (UPEP) and urine immunofixation can measure myeloma protein (Bence Jones protein) filtered through the kidney
• Blood tests: In addition to a complete blood count, your doctor will do blood chemistry tests to measure levels of creatinine, albumin, calcium, proteins and other elements that may indicate myeloma
  • Quantitative immunoglobulins: Measure levels of different antibodies (called immunoglobulins), including IgA, IgD, IgE, IgG and IgM
  • Electrophoresis: Serum protein electrophoresis (SPEP) measures antibodies in the blood and can find a monoclonal antibody 
  • Immunofixation or immunoelectrophoresis: Determines the exact type of abnormal antibody
  • Serum-free light chains: Measures light chain levels in the blood 
  • Beta-2 microglobulin: A myeloma cell protein and a useful indicator of a patient’s prognosis 
• Biopsies: Your doctor may order one or several different types of biopsies. A small sample is taken from different tissue that may be affected and sent to pathology for study
  • Bone marrow biopsies: Immunohistochemistry, flow cytometry, cytogenetics and fluorescent in situ hybridization (FISH)
  • Fine needle aspiration biopsy
  • Core needle biopsy
• Imaging tests: Imaging tests make pictures of the inside of your body to help doctors see a suspicious area more closely to determine if cancer has spread or if a treatment is working
  • Bone x-rays
  • Computed tomography scan (CT) scan
  • Magnetic resonance imaging (MRI) scans
  • Positron emission tomography (PET) scans
  • Echocardiogram (ECHO) 

Diagnosing Multiple Myeloma

There are several types of myeloma. Multiple myeloma is the most common type, accounting for 90% of cases according to the Leukemia and Lymphoma Society. After medical tests are complete, your doctor will review the results. A diagnosis of multiple myeloma requires either:

• A plasma cell tumor (biopsy) 
  - OR -
• At least 10% of plasma cells in the bone marrow 
  - AND -
• At least one of the following:
  • High blood calcium level
  • Poor kidney function
  • Low red blood cell counts (anemia)
  • Holes in the bones from tumor found (imaging tests)
  • Increase in one type of light chain so it’s 100 times more common than the other
  • 60% or more plasma cells in the bone marrow

Diagnosing Smoldering Myeloma

Smoldering myeloma is an early, precancerous form of myeloma that may have some signs of multiple myeloma, but not causing any symptoms. A diagnosis of smoldering myeloma requires:

• 10% to 60% plasma cells in bone marrow 
• High level of M protein in the blood
• High level of Bence Jones protein in the urine

Diagnosing Light Chain Amyloidosis

A biopsy, a blood test and/or a urine test may be used to diagnose light chain amyloidosis. A diagnosis includes all of the following:

• Signs and symptoms of amyloidosis
• Amyloid in any tissue
• Amyloid protein is a light chain (not a heavy chain)
• Abnormal plasma cells in the bone marrow, high levels of M protein in the blood or high levels of M protein in the urine

Here at Banner MD Anderson, we’re at the forefront of multiple myeloma diagnosis, treatment and care. If you need diagnostic testing for multiple myeloma, make an appointment with our team of cancer experts.

What Is the Prognosis for Multiple Myeloma?

Researchers are hard at work learning about multiple myeloma and developing new ways to treat it. Currently, there isn’t a cure for multiple myeloma, but survival rates have gone up dramatically in the past 20 years. With so much still unknown about this disease, it’s difficult to predict outcomes. Everyone is different, so a patient’s age, treatment, overall health and other factors will affect their prognosis. 

Multiple Myeloma Stages

Following diagnosis, your doctor will give your cancer a stage based on how far it has progressed. For multiple myeloma staging, doctors use the international staging system (ISS) based on blood test results.

• Smoldering: Myeloma cells are present, but not active and with no symptoms.
• Stage 1: Small number of myeloma cells present, but not progressing, not causing symptoms or damage.
• Stage 2: Moderate number of myeloma cells present, cancer is progressing, causing damage and multiple symptoms.
• Stage 3: High number of myeloma cells present, cancer is in multiple parts of the body, causing damage and patient is experiencing complex symptoms.

If you have symptoms of multiple myeloma, talk to your doctor about any questions you may have.

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