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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

Imaging Studies

  • X-Rays are the first imaging study done to search for myeloma-caused bone damage.  A full skeletal x-ray survey is needed to demonstrate loss or thinning of bone (osteoporosis or osteopenia), holes in bone (lytic lesions),  and/or fractures.  X-rays are simple to do and are inexpensive.  Their limitations are that 30% or more of the bone must be missing before x-ray can reveal the damage, and that damage to a bone shows up permanently on x-ray, even if there is no longer any active myeloma.
  • MRI (Magnetic Resonance Imaging) is a non-invasive study that uses magnetic energy to produce a detailed two- or three-dimensional image of structures inside the body.  It is useful for imaging plasmacytomas (tumors formed from massing of myeloma cells inside or outside the bone marrow); infiltration of the bone marrow by clumps of myeloma; and compression of the spinal cord.  Although it is useful for detecting new disease rapidly, there is a 9-month or more lag time before an MRI will look normal after an area of myeloma has been successfully treated and is no longer active.    It is an expensive study compared to x-ray, takes 30-60 minutes to complete, and covers a limited area of the body. 
  • CT or CAT Scan (Computerized Axial Tomography) uses x-ray technology to create a three-dimensional digital image of the body.  It is a much more precise study than x-ray, and can provide clear, detailed images of bone.  Downsides include expense, limited coverage of the body, and the need to use contrast agents that can pose problems for myeloma patients with kidney dysfunction.
  • PET Scan (Positron-Emission Tomography) requires that a patient be injected with a sugar-fluorine compound (FDG, or fluoro-deoxyglucose) that is taken up by the body's actively multiplying cells.  When the body is scanned, the areas with the highest concentrations of fluorine "glow," revealing "hot spots" where rapid metabolism can indicate areas of cancer cells.  This scan covers the whole body, is very sensitive in detecting potential tumor activity, and is the only "real-time" imaging study.  It is a valuable tool for patients who do not secrete monoclonal protein and whose myeloma is therefore difficult to assess, and for situations where x-ray, MRI, and CT do not provide enough information about potential new disease.  It is, however, expensive and time-consuming, requiring 90-150 minutes to perform.
  • PET/CT combines PET and CT scans in one imaging study, providing information both about past damage and current cancer activity, thus enabling the doctor to study changes over time.  It is a highly accurate study, but like standard PET, it is expensive and time-consuming.
Mike Katz, IMF Board Member

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Bone Disease in Multiple Myeloma
Dr. Brian Durie
Washington, DC 2009 Patient & Family Seminar
August 7-8, 2009

International Myeloma Working Group Guidelines on Imaging Techniques in the Diagnosis and Monitoring of Multiple Myeloma1
These guidelines represent a capsule summary, capturing the main points of, but not intended to replace the publication (listed to the right) from which they came.
International Myeloma Working Group Consensus Statement and Guidelines Regarding the Current Role of Imaging Techniques in the Diagnosis and Monitoring of Multiple Myeloma
Published in Leukemia (2009), 1–12