Patients often have no symptoms in the early stages of multiple myeloma. When symptoms do appear, they may be vague and mimic those of other medical conditions, especially since those who get the disease are generally older. Multiple myeloma is often diagnosed after patients have routine blood tests to check for another condition.

A complete blood count (CBC) is used to determine if a patient has anemia, thrombocytopenia, or leukopenia. Albumin, blood urea nitrogen (BUN), calcium, creatinine, and lactate dehydrogenase (LDH) levels are also of value. Increased BUN and creatinine levels indicate decreased kidney function, while LDH levels help assess tumor cell burden.¹

The serum level of beta-2 microglobulin (ß2-M) reflects the tumor mass and is now considered a standard measure of tumor burden. C-reactive protein is a surrogate marker for interleukin (IL)-6, a growth factor for myeloma cells. Protein electrophoresis is used to characterize and quantitate the proteins in blood or urine. Immunoelectrophoresis (IEP) or immunofixation may be used to better understand the abnormal immunoglobulins and to track the progression of myeloma disease and response to treatment.¹

A 24-hour urine protein and urine protein electrophoresis (UPEP) test may be ordered for patients (about 50%) who show the presence of myeloma protein in the urine. These tests help stage the disease and assess its progression and response to treatment.¹

A complete series of skeletal images may be done at diagnosis, including the skull (a common site of bone lesions in multiple myeloma), the long bones, and the spine. Diffuse osteopenia may suggest myelomatous involvement before discrete lytic lesions are apparent. Findings from this evaluation may be used to identify impending pathologic fractures, allowing physicians the opportunity to repair debilities and prevent further morbidity.

Bone scans should not be used to evaluate myeloma. Cytokines secreted by myeloma cells suppress osteoblast activity; therefore, typically, no increased uptake is observed.

Symptomatic patients should be evaluated with magnetic resonance imaging (MRI) to obtain a clear view of the spinal column and to assess the integrity of the spinal cord. Findings from MRI scans of the vertebrae are often positive when plain radiographs are not.²

Bone marrow aspirate (liquid) or bone marrow biopsy (solid) samples may be obtained to calculate the percent of plasma cells in the aspirate (reference range, ≤3%) and to look for sheets or clusters of plasma cells in the biopsy specimen. Multiple myeloma is probable if 10% or more of the cells in the bone marrow sample are plasma cells.¹

Cytogenetic analysis of the bone marrow may contribute significant prognostic information. Abnormalities of chromosome 13 (predominantly monosomy 13) predict a poor outcome. In addition, in persons with MGUS, the presence of monosomy 13 may correlate with subsequent development of myeloma.²

1.	Berenson JR, San Miguel J. Diagnosis. Multiple Myeloma Research Foundation. Available at http://www.multiplemyeloma.org/about_myeloma/2.05.html. Accessed December 2004.
2.	Grethlein S. Multiple Myeloma. Emedicine. Available at http://www.emedicine.com/med/topic1521.htm#target1. Accessed December 2004.