Fast Five Quiz: Key Aspects of Multiple Myeloma

Emmanuel C. Besa, MD


September 26, 2019

Workup for patients with multiple myeloma includes the following:

  • Serum and urine assessment for monoclonal protein (densitometer tracing and nephelometric quantitation; immunofixation for confirmation)

  • Serum-free light chain assay (in all patients with newly diagnosed plasma cell dyscrasias)

  • Bone marrow aspiration and/or biopsy

  • Serum beta-2 microglobulin, albumin, and lactate dehydrogenase measurement

  • Standard metaphase cytogenetics

National Comprehensive Cancer Network (NCCN) guidelines recommend the use of serum-free light chain assay and plasma cell fluorescence in situ hybridization (FISH) for del 13, del 17p13, t(4;14), t(11;14), 1q21 amplification as part of the initial diagnostic workup.

In patients with suspected multiple myeloma, a 24-hour urine collection should be obtained for quantification of the Bence Jones protein (ie, lambda light chains), protein, and creatinine clearance. Routine urinalysis may not indicate the presence of Bence Jones proteinuria. Therefore, a 24-hour urinalysis by means of urine protein electrophoresis or immunoelectrophoresis may be required. Quantification of proteinuria is useful for diagnosis (>1 g of protein in 24 hours is a major criterion) and for monitoring the response to therapy. Creatinine clearance can be useful for defining the severity of the patient's renal impairment.

Perform a complete blood count (CBC) to determine whether the patient has anemia, thrombocytopenia, or leukopenia. The CBC and differential may show pancytopenia. The reticulocyte count is typically low. Peripheral blood smears may show rouleaux formation. The ESR is typically increased. Coagulation studies may yield abnormal results.

Suppression of nonmyelomatous immunoglobulin is a minor diagnostic criterion for multiple myeloma. The level of multiple myeloma protein (ie, M protein level), as documented by the immunoglobulin level, can be useful as a marker to assess the response to therapy.

Read more about the workup of multiple myeloma.


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