Multiple Myeloma

Testing & Diagnosing

Diagnosing multiple myeloma is challenging. The symptoms you may feel can often be attributed to other conditions, or you may not have symptoms at all. As a result, multiple myeloma may be at an advanced stage when it is diagnosed.

A variety of tests will help your doctor diagnose multiple myeloma. After diagnosis, many of these tests will be repeated to monitor disease progression and determine the effectiveness of treatment.

Laboratory Tests

You may have one or more of these blood and urine tests.

24-hour urine protein test measures the levels of specific proteins that may indicate the presence and extent of multiple myeloma. Other substances, such as creatinine (Cr), are also measured.

Beta-2-microglobulin test looks for a protein in the blood made by cancer cells. A high level may indicate a large number of cancer cells.

Blood chemistry test measures blood urea nitrogen (BUN), Cr and other substances. Higher levels of BUN and Cr can indicate impaired kidney function, which is common with multiple myeloma.

Complete blood count (CBC) measures the levels of white blood cells, red blood cells (including hematocrit and hemoglobin) and platelets in the blood. Low counts may indicate the presence of excessive myeloma cells in the bone marrow.

Free light chain analysis measures a specific part of an antibody in the blood known as a light chain. The presence of increased numbers of one type of free light chain (i.e., not part of intact antibody) is associated with multiple myeloma, MGUS and amyloidosis (a rare disease caused by a buildup of an abnormal protein).

Immunofixation (IFE) test identifies and measures small amounts of abnormal protein in the blood (serum immunofixation) or urine (urine immunofixation).

Quantitative immunoglobulin test measures levels of major subtypes of antibodies, also known as immunoglobulins.

Serum protein electrophoresis (SPEP) measures the proteins in the blood and can indicate the presence of the M-protein created by myeloma cells. Knowing the levels helps your doctor determine the diagnosis and extent of the disease. During treatment, levels are tested to monitor the effectiveness of therapy.

Urine protein electrophoresis (UPEP) looks for an M-spike, which occurs when M-proteins are excreted by the kidneys into the urine.


Your doctor may order a bone marrow biopsy and/or bone marrow aspiration to collect multiple samples for examination by a pathologist (a doctor who specializes in diagnosing disease by studying cells and tissues under a microscope). The biopsy sample is usually taken from the pelvic bone. Bone marrow aspiration involves removing liquid bone marrow.

A biopsy of fat from around your stomach may be taken to check for amyloidosis, a buildup of amyloid, an abnormal protein.

Specialized Testing

Results of special tests are enabling doctors to use a more personalized approach to create a treatment plan for the long term.

Cytogenetics is the study of evaluating cells for chromosome abnormalities by looking for genetic changes at the DNA level. Abnormalities, such as chromosomes that are broken, rearranged or missing, may indicate the level of disease.

Doctors may use fluorescence in situ hybridization (FISH), a test used to look for abnormal cells that may be associated with a more advanced myeloma. A fluorescent dye is used to highlight specific genes or areas of chromosomes under a microscope.

Gene-expression profiling and next-generation sequencing help doctors understand how a patient’s disease will behave.

Imaging Tests

After diagnosing multiple myeloma, imaging tests are routinely used to check for damage caused by the disease and to help determine the extent and spread.

Computed tomography (CT) is used to look for tumors or abnormalities in soft tissues. Magnetic resonance imaging (MRI) uses magnetic fields instead of X-rays to visualize internal structures of the body. Positron emission tomography (PET) also creates images of organs and tissues that can be helpful in determining whether cancer has spread to the lymph nodes. PET should be combined with CT, which is known as PET/CT. X-rays use a low dose of radiation beams that create images of structures inside the body. Your doctor may use these images to look for bone damage. 


Making a Multiple Myeloma Diagnosis

A definitive diagnosis must include one of the following:

  1. A very high proportion of plasma cells in the bone marrow
  2. Biopsy results indicating a plasma cell tumor, or
  3. Abnormal plasma cells making up 10 percent of the cells in the bone marrow, plus one of the following conditions:
  • Abnormally high level of M-protein
  • Anemia (low red blood cell count)
  • Hypercalcemia (increased blood calcium level)
  • Poor renal (kidney) function
  • Abnormalities or holes in the bones or bone marrow found on an imaging test
  • An increase in one light chain (antibody protein) to a level 100 times that of the others


Key Takeaways

  • A multiple myeloma diagnosis is made only when very specific criteria are met.
  • Doctors can gain valuable treatment planning information from test results that indicate genetic abnormalities.
  • You will continue to have tests to monitor treatment effectiveness and disease progression.

Additional Resources


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