We are international
• about myeloma TEXT SIZE   
Diagnosis and Staging



The International Myeloma Foundation is proud to have sponsored and coordinated the development of the International Staging System (ISS) for Multiple Myeloma in 2005. The ISS was developed through a collaborative research initiative conducted by 17 myeloma institutions around the world.  Based on that research, the factors found to best stratify patients’ prognosis into a three-stage classification were two blood proteins: serum beta 2 microglubulin and serum albumin.

In August, 2015 the International Myeloma Working Group (IMWG) published its Revised International Staging System (R-ISS), which combines the ISS with chromosomal abnormalities detected by interphase fluorescent in situ hybridization (FISH) and serum lactate dehydrogenase (LDH). Clinical data from 4,445 patients with newly diagnosed myeloma in 11 international clinical trials were pooled and analyzed to create this updated simple yet powerful prognostic staging system.   



Serum ß2 microglobulin < 3.5 mg/l
Serum albumin ? 3.5 g/dl
Standard-risk chromosomal abnormalities (CA)
Normal LDH

Not R-ISS stage I or III

Serum ß2 microglobulin ? 5.5 mg/L and either
High-risk CA by FISH
High LDH

Related Links:

Understanding Your Test Results

Revised International Staging System for Multiple Myeloma

©2015 International Myeloma Foundation


Blood & Urine
Blood Tests are done routinely at the time of diagnosis and throughout the disease course to assess response to treatment and side effects, and to monitor for possible relapse.
  • Complete blood count (CBC) assesses the presence or absence of anemia, low white cell count, and low platelet count
  • Chemistry/Metabolic Panel is particularly important for assessing kidney function (creatinine and BUN), albumin, calcium level, and LDH
  • Serum Protein Electrophoresis (SPEP) assesses the amount of abnormal (monoclonal) protein
  • Immunofixation demonstrates the type of myeloma protein; i.e., heavy chain (G, A, D, or E); or light chain (kappa or lambda)
  • Immunoelectropheresis measures immunoglobulins in the blood or urine. Immunoglobulins are produced by plasma cells, including most myeloma cells.
  • Freelite® test (serum free light chain assay) is used to measure the number of free kappa or free lambda light chains (fragments of the monoclonal protein) if it is not possible to quantify heavy chains with serum protein electrophoresis or light chains with urine protein electrophoresis. Some patients' myeloma cells secrete very little or no monoclonal protein that can be detected with SPEP or UPEP; the majority of these patients can be tested adequately with the serum free light chain assay.
Urine Tests
  • Urine Protein Electrophoresis (UPEP) shows the amount of monoclonal protein in the urine. Patients must collect urine for 24 hours and it is then sent to the lab for UPEP. Only monoclonal light chains, not heavy chains, are found in urine. Approximately 30% of patients have light chain protein in their urine as well as heavy and light chains in the blood. Approximately 10% of patients have myeloma cells that produce only light chains and no heavy chains.
  • Urine Immunofixation identifies the type of abnormal myeloma protein in the urine (kappa or lambda light chains).
Blood And Urine Tests
Lab Tests Online
Like many areas in medicine, clinical lab testing often provides few simple answers to commonly asked questions. The issues - on topics like insurance reimbursement and reference ranges - can be very complex. This web site will help you to understand the issues a bit better and help you to ask the appropriate questions of your doctor.

Serum Free Light Chain Assay or the Freelite™ Test
Myeloma is a cancer of the plasma cells in the bone marrow. The function of normal plasma cells is to produce antibodies, also known as immunoglobulins, which have an important role in fighting infection. Each type of plasma cell produces only one type of immunoglobulin. Normal immunoglobulins are composed of smaller units called heavy chains and light chains. Each plasma cell also produces only one type of heavy chain and one type of light chain. When the light chains are attached to the heavy chains, the light chains are referred to as bound light chains. When the light chains are not attached to the heavy chains, they are called free light chains. In individuals with myeloma and related disorders such as monoclonal gammopathy of undetermined significance (MGUS), excess light chains enter the bloodstream. as free light chains. The amount of free light chain production is linked to the activity of myeloma or plasma cell growth.