If doctors suspect that you have multiple myeloma, you may undergo a variety of tests. These include blood, urine, bone marrow, and imaging tests. Oncologists, radiologists, and pathologists will review the results. They will determine whether you have the disease, if it appears to be active, and how much it has spread. Having an accurate diagnosis and assessment of your disease is the first step in getting the right care. It is important that a diagnosis is well established before beginning any treatment for multiple myeloma.

Blood and Urine Tests

Compared with normal plasma cells, myeloma cells produce excessive amounts of an immunoglobulin protein called monoclonal protein. Blood and urine tests look for excessive proteins and reveal the type of proteins present, which may be different for each patient. The protein type is a unique marker for tracking the disease and monitoring the progress of the treatment.

Myeloma cells also affect normal bone marrow cells, which leads to reduction of the number of normal red and white blood cells produced. Blood tests can measure the number of these cells to determine whether the levels are abnormally low. Tests can also measure how well the kidneys are working and several other factors that indicate the extent of the disease.

Bone Marrow Aspiration and Biopsy

During a bone marrow aspiration and biopsy, a thin needle is inserted into the pelvic bone to collect bone marrow for a pathologist to examine. You will receive local anesthesia to numb the area first. A small amount of bone marrow fluid and cells is obtained during a bone marrow aspiration. A bone marrow biopsy collects a small sample of the bone with the marrow inside. The two procedures are usually performed together. In some cases, you may need only an aspiration.

In a healthy person, plasma cells account for 2 to 3 percent of the cells in the bone marrow. A bone marrow biopsy containing more than 10 percent plasma cells is suggestive of multiple myeloma.

Pathologists also use the bone marrow tissue to perform tests on the chromosomes of cancerous plasma cells collected from the bone marrow. People with myeloma whose plasma cells contain chromosomal abnormalities usually have poorer outcomes, but it depends on the abnormality.

In addition, the bone marrow tissue is examined with a lab technique called flow cytometry. This analyzes the surface of the plasma cells to help make a diagnosis. It is also useful for tracking the disease after treatment.

Imaging Studies

Our doctors use imaging tests to determine the number, size, and location of the disease in the bones and other tissues, such as the kidneys, muscles, heart, and digestive tract. Most people will have PET scans or MRI scans.

Determining the Extent of Disease

From these tests, our doctors can determine if you have no symptoms (smoldering myeloma) or if there are signs that your organs are affected (active myeloma). This information helps you and your doctors determine if you need treatment. If you do need treatment, you and your care team will set your treatment goals and select the therapy that offers you the best chance to control your disease.

Smoldering Myeloma

If you have no symptoms and no organ damage, you have what is called smoldering or asymptomatic myeloma. Our doctors will monitor you closely for any signs that the disease is becoming active. Smoldering myeloma is not usually treated with medicine except in a clinical trial.

If your protein levels start to rise steadily or you experience symptoms of bone damage, elevated calcium in the blood, or signs of anemia or organ damage, the disease may have become active. At this point, your doctor will likely begin active treatment.

Multiple Myeloma Stages

If you have myeloma symptoms or signs of organ damage, you have symptomatic (active) myeloma and will need to receive treatment. For symptomatic myeloma, your doctors will rely on the results of your blood tests to classify your disease There are three stages — I, II, or III. To assign the stage, doctors use the International Staging System (ISS) and the Revised International Staging System (R-ISS). The ISS for myeloma, published in 2005, relies on measuring the levels of beta 2 microglobulin (β2M) and albumin. In 2015, the ISS was updated to the R-ISS. It also includes the level of lactate dehydrogenase and chromosomal abnormalities. These scoring systems help your doctors determine your prognosis.