THE MYELOMA PATIENT'S GUIDE TO
Understanding Your Test Results
Myeloma is a complex disease that can
n Serum Protein Electrophoresis (SPEP)
have different features in each patient.
Assesses the amount of abnormal (monoclonal) protein.
No single test or study is adequate to tell
n Urine Protein Electrophoresis (UPEP)
the whole story about a patient's status,
Shows the amount of monoclonal protein in the urine. Patients
but used together, test results give a
must collect urine for 24 hours and it is then sent to the lab
more complete picture than any single
for UPEP. Only monoclonal light chains, not heavy chains, are
test does.
found in urine. Approximately 30% of patients have light chain
Normal lab values (usually shown as a
protein in their urine as well as heavy and light chains in the
range in parentheses next to your lab result) vary from lab to lab.
blood. Approximately 10% of patients have myeloma cells that
Note that the metric system units (grams or milligrams, liters or
produce only light chains and no heavy chains.
deciliters, etc.) may also vary from lab to lab. Make sure you are
n Immunofixation (IFE)
comparing results expressed in the same units. If your lab result
Provides information as to the presence or absence of a
falls below the lower limit of normal, or above the upper limit of
monoclonal protein as well as the type of myeloma protein;
normal, your reported lab value will be followed by a symbol to
i.e., heavy chain (G, A, D, or E); and/or light chain (kappa
let you know that it is out of range (usually an "H" for high or an
or lambda).
"L" for low). You should discuss the significance of any abnormal
n Quantitative Immunoglobulins
lab value with your physician. In general, test results best reflect
Shows the total amount of IgG, IgA, and IgM, both normal and
a patient's status when looked at over time. A trend, or pattern,
abnormal (spike).
often reveals more than a single result.
n Freelite® test (Serum Free Light Chain assay, SFLC)
Test results are the most important tools you and your
Used to measure the number of free kappa or free lambda light
chains (fragments of the monoclonal protein) if it is not possible
hematologist/oncologist have in order to:
to quantify heavy chains with serum protein electrophoresis,
n Diagnose active multiple myeloma versus the earlier disease
conditions called MGUS and asymptomatic ("smoldering")
or light chains with urine protein electrophoresis. Some
myeloma
patients' myeloma cells secrete very little or no monoclonal
n Assess the stage of your myeloma and the presence or
protein that can be detected with SPEP or UPEP. The majority
absence of good or poor risk features
of these patients can be tested adequately with the serum free
n Determine if you need to begin treatment
light chain assay.
n Determine the best treatment option(s)
n Routine urinalysis
n Evaluate your response to treatment
Can show the presence of protein and/or may indicate evidence
n Monitor the course of your myeloma
of kidney damage or infection.
over time.
n Urine Immunofixation (urine IFE)
Tests for myeloma fall into several groups:
As for IFE in the serum, indicates both the presence or absence
n Laboratory tests (blood and urine)
as well as the type of monoclonal protein.
n Imaging studies (skeleton)
IMAGING STUDIES
n Pathology studies (biopsies)
n Genetic studies (done on biopsy specimens)
n X-rays
n There are also tests used in special circumstances
Are the first imaging study
(amyloidosis, neuropathy, kidney or infectious
done to search for myeloma-
complications). These tests are beyond the scope of this
caused bone damage. A full
information card because they are not used routinely.
skeletal x-ray survey is needed to demonstrate loss or thinning
LABORATORY TESTS
of bone (osteoporosis or osteopenia), holes in bone (lytic
lesions), and/or fractures. Typically x-rays are simple to do.
n Complete blood count (CBC)
Their limitations are that 30% or more of the bone must be
Gives information about the presence or
missing before x-ray can reveal the damage, and that damage
absence of anemia, and/or low white cell
to a bone shows up permanently on x-ray, even if there is no
count, and/or low platelet count.
longer any active myeloma.
n Chemistry/Metabolic Panel
n CT or CAT scan (Computerized Axial Tomography)
Provides the blood calcium level; serum
Uses x-ray technology to create a three-dimensional digital
creatinine as a measure of kidney
image of the body. It is a much more precise study than x-ray,
function; and liver function test results.
(continues on other side)
and can provide clear, detailed images of bone. Downsides
GENETIC STUDIES
include limited coverage of the body, and the possible need
to use contrast agents that can pose problems for myeloma
n Metaphase Cytogenetics (karyotyping)
patients with kidney dysfunction.
A test in which the bone marrow biopsy specimen is placed
into a special dish and allowed to grow in the laboratory. Cells
n MRI scan (Magnetic Resonance Imaging)
are later taken from the growing sample and stained. The
A non-invasive study that uses magnetic energy to produce a
laboratory specialist uses a microscope
detailed two-or three-dimensional image of structures inside
to examine the size, shape, and number
the body. It is useful for imaging plasmacytomas (tumors
of chromosomes in the cell sample. The
formed from massing of myeloma cells inside or outside the
chomosomes can only be examined
bone marrow); infiltration of the bone marrow by clumps of
in this way if the cells are undergoing
myeloma; and compression of the spinal cord. Although it is
active cell division (metaphase). The
useful for detecting new disease rapidly, there is a 9-month or
stained sample is photographed to
more lag time before an MRI will look normal after an area
provide a karyotype, which shows the
of myeloma has been successfully treated and is no longer
arrangement of the chromosomes.
active. It is an expensive study compared to x-ray and CT, takes
Certain abnormalities can be identified
3060 minutes to complete, and covers a limited area of
through the number or arrangement of the chromosomes.
the body.
This test is particularly valuable for identifying higher-
n PET scan (Positron-Emission Tomography)
than-average-risk myeloma in patients with fewer than
Requires that a patient be injected with a sugar-fluorine
two copies of each chromosome (hypodiploidy) and
compound (FDG, or fluoro-deoxyglucose) that is taken up by
in those with deletion of chromosome 13 during
the body's actively multiplying cells. When the body is scanned,
cell division.
the areas with the highest concentrations of fluorine "glow,"
n Fluorescense In Situ Hybridization (FISH)
revealing "hot spots" where rapid metabolism can indicate
Provides researchers with a way to visualize and map the
areas of cancer cells. This scan covers the whole body, is very
genetic material in an individual's cells, including specific
sensitive in detecting potential tumor activity, and is the only
genes or portions of genes. This is important for understanding
"real-time" imaging study. It is a valuable tool for patients who
a variety of chromosomal abnormalities and other genetic
do not secrete monoclonal protein and whose myeloma is
mutations. Unlike metaphase cytogenetics, FISH does not
therefore difficult to assess, and for situations where x-ray, MRI,
have to be performed on cells that are actively dividing. It
and CT do not provide enough information about potential
is useful for defining high-risk myeloma in patients with
new disease. It is, however, expensive and time-consuming,
certain chromosomal translocations and deletions, especially
requiring 90150 minutes to perform.
t(4;14) and 17p-, in which the top part of chromosome 17 is
n PET/CT
lost (missing).
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.
n Bone density testing
Helpful for monitoring the
bones of patients who have
diffuse thinning (osteopenia
or the more severe condition
osteoporosis) of the bone cortex. Improvement with thickening
of bone (increased density) occurs with the benefit of using
bisphosphonate therapy.
PATHOLOGY STUDIES
n Bone marrow biopsy
Performed to assess the percentage of myeloma cells in the bone
marrow and to determine how much they differ from normal
800.452.CURE (2873)
plasma cells. Special testing is done on the bone marrow biopsy
in the US & Canada
sampletoassessprognosisbasedonchromosomalabnormalities.
818.487.7455
(See "Genetic Studies" below.)
n Other tissue biopsy
International Myeloma Foundation
May be performed if the hematologist/oncologist is concerned
12650 Riverside Drive, Suite 206
North Hollywood CA 91607-3421
about amyloidosis or extramedullary (outside the bone
marrow) disease.
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