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Diagnosis and Staging


Myeloma can have different features in each patient. It is important to understand your disease and to know which tests are best for monitoring your myeloma. No single test or study is adequate to tell the whole story about a patient’s status, but used together, test results give a more complete picture. 

Understanding Testing

You should discuss the significance of any abnormal lab value with your physician. In general, test results best reflect a patient's status when looked at over time. A trend, or pattern, often reveals more than a single result. Test results are the most important tools you and your hematologist/oncologist have to:

  • Diagnose active multiple myeloma versus the earlier disease conditions called MGUS and asymptomatic (“smoldering”) myeloma
  • Assess the stage of your myeloma and the presence or absence of good or poor risk features
  • Determine if you need to begin treatment
  • Determine the best treatment option(s)
  • Evaluate your response to treatment
  • Monitor the course of your myeloma over time.

Types of Tests

Tests for myeloma fall into several groups:

  • Laboratory tests (blood and urine)
  • Imaging studies (skeleton)
  • Pathology studies (biopsies)
  • Genetic studies (done on biopsy specimens)
  • There are also tests used in special circumstances (amyloidosis, neuropathy, kidney or infectious complications).      

Click here for The Myeloma Patient’s Guide to Understanding Your Test Results http://myeloma.org/pdfs/U-TestResults.pdf


The International Myeloma Foundation is proud to be the sponsor for the International Staging System (ISS) (previously called the International Prognostic Index or IPI) for multiple myeloma. The ISS is a collaborative research initiative with nearly 20 myeloma institutions from around the world.
The new International Staging System (ISS) provides a prognostic factor alternative to the Durie and Salmon clinical staging system used for more than 25 years. The ISS is a simple, objective and cost-effective new staging system that can be used around the world and takes the guess-work out of staging while allowing precise, individualized treatment selection. It is based upon two blood test results: serum ß2microglobulin (Sß2M) and serum albumin. These two blood proteins were selected from among various other prognostic factors because of their statistical power and the wide availability of these two simple inexpensive laboratory tests.

Baseline testing is required to:

  • Determine the exact diagnosis:
    • Monoclonal Gammopathy linked to another medical condition
    • Monoclonal Gammopathy of Undetermined Significance (MGUS)
    • Smoldering myeloma: low risk
    • Smoldering myeloma: high risk
    • Active myeloma for which systemic anti-myeloma treatment is recommended.
  • To form the basis for the selection of the most appropriate anti-myeloma treatment and supportive care as well as provide a comprehensive baseline to adequately monitor response to treatment. Response to treatment is assessed by comparisons with baseline clinical features and laboratory test results.

Recommended baseline tests:

Click to view and/or download the slides for Step 2.


©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.