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Biopsies

TESTS YOU REALLY NEED

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

Staging

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.

REFERENCES

©2015 International Myeloma Foundation

Biopsies

BONE MARROW BIOPSIES

Bone marrow biopsies are performed routinely to diagnose myeloma. They are also used for periodic monitoring of myeloma during the course of treatment. Bone marrow biopsies provide information about the amount of disease, the type of disease, its aggressiveness, and molecular/genetic abnormalities that help to predict the disease course. They provide the only direct access to tumor cells for examination by a pathologist, so they are necessary even though they are invasive and can be painful. Moreover, because myeloma is patchy and is not distributed evenly throughout the bone marrow, bone marrow biopsies do not always present an accurate sample of what is occurring elsewhere in the marrow.

OTHER TISSUE BIOPSIES

Other tissue biopsies are performed less frequently to determine if myeloma is present outside the bone marrow, or in early stage disease, to biopsy a solitary plasmacytoma.

BIOPSIES
Mike Katz, IMF Board Member