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When myeloma is diagnosed, the amount of myeloma in the body varies from patient to patient. This is called the stage of myeloma. Several tests (assessments of so-called prognostic factors, from the Greek words that mean "knowing ahead") can be used to assess how aggressive the myeloma is in a given patient. In general, higher or abnormal test results indicate more active myeloma, and possibly, less likelihood of having a long response with treatment.
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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).
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Blood And Urine Tests
Mike Katz, IMF Board Member
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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. |
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Learn more about a new type of laboratory test called the serum Free Light Chain assay. This test is also known as the Freelite™ test. |
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The test is particularly useful for patients with non-secretory myeloma and is considered as a potential replacement for the 24 hour urine test |
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The FreeLite Test
Mike Katz, IMF Board Member
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Understanding Serum Free Light Chain Assays
Dr. Karen Van Hoeven, The Binding Site
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Includes summary of the International Myeloma Working Group guidelines on the use of serum free light chain analysis and assessing response in myeloma. |
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