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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


Genetic Testing is performed on a patient's bone marrow biopsy specimen at the time of diagnosis to help predict the behavior of the myeloma and its response to various treatment strategies.   A patient's biopsy specimen may be sent to a large academic center for genetic testing if the local oncologist is not associated with a laboratory that is equipped to perform the tests.

  • Conventional Metaphase Cytogenetics  (karyotyping) is a test in which the bone marrow biopsy specimen is placed into a special dish and allowed to grow in the laboratory.  Cells are later taken from the growing sample and stained. The laboratory specialist uses a microscope to examine the size, shape, and number of chromosomes in the cell sample.  The stained sample is photographed to provide a karyotype, which shows the arrangement of the chromosomes.  Certain abnormalities can be identified through the number or arrangement of the chromosomes.   This test is particularly valuable for identifying higher-than-average-risk myeloma in patients with fewer than two copies of each chromosome (hypodiploidy) and in those with deletion of chromosome 13 during cell division.
  • Fluorescence In Situ Hybridization (FISH) provides researchers with a way to visualize and map the genetic material in an individual's cells, including specific genes or portions of genes. This is important for understanding a variety of chromosomal abnormalities and other genetic mutations. Unlike most other techniques used to study chromosomes, FISH does not have to be performed on cells that are actively dividing.  It is useful for defining high-risk myeloma in patients with certain chromosomal translocations (which occur when chromosomes inappropriately exchange sequences of genetic material during cell division) and/or in those who have a deletion of the short arm of chromosome 17.
Role of FISH in Myeloma Risk Stratification
XIIth International Myeloma Workshop in Washington, DC
Rafael Fonseca, M.D.
Mayo Clinic
Scottsdale, Arizona
Genetic Changes in Myeloma: Prognostic Implications
XIIth International Myeloma Workshop in Washington, DC
Herve Avet-Loiseau, M.D.
Institute de Biologie
Nantes, France

International Myeloma Working Group (IMWG) Molecular Classification of Multiple Myeloma: Spotlight Review
Published in Leukemia (2009), 1–12