THEMYELOMAPATIENT'SGUIDETO
UNDERSTANDINGYOURTESTRESULTS
Myelomaisacomplexdiseasethatcanhavedifferentfeaturesineachpatient.No
singletestorstudyisadequatetotellthewholestoryaboutapatient'sstatus,but
used together,testresultsgiveamorecompletepicturethananysinglettestdoes.It
isimportantforyouandyourdoctortounderstandyourdiseaseandtoknowwhich
testsarebestformonitoringyourmyeloma.
Thefollowinginformationisdesignedtohelpfamiliarizeyouwiththevarioustests
used indiagnosingandmonitoringmultiplemyelomaandtohelpyouw
workwith
yourdoctorinmakingthemostoftheinformationtheyprovide.Itisimportantto
notethatthenormallabvalues(arange,usuallysshowninparenthesesnexttoyour
labresult)varyfromlabtolab.Ifyourlabresultfallsbelowthelowerlimitof
normalorabovetheupperlimitofnormal,yourreportedlabvaluewillbefollowed
byasymboltoletyouknowthatitisoutofrange (usuallyan"H"forhighoran"L"
forlow).Youshoulddiscussthesignificanceofanyabnormallabvaluewithyour
physician.
Testresultsarethemostimportanttoolsyouandyourhematologist/oncologist
haveto:
Diagnoseactivemultiplemyelomaversustheearlierdiseaseconditions
calledMGUSandasymptomatic("smoldering")myeloma
Assessthestageofyourmyelomaandthepresenceorabsenceofgoodor
poorriskfeatures
Determineifyouneedtobegintreatment
Determinethebesttreatmentoption(s)
Evaluateyourresponsetotreatment
Monitorthecourseofyourmyelomaovertime.
Testsformyelomafallintoseveralgroups:
Laboratorytests(bloodandurine)
Imagingstudies(skeleton)
Pathologystudies(biopsies)
Geneticstudies(doneonbiopsyspecimens)
Therearealsotestsusedinspecialcircumstances(amyloidosis,neuropathy,
kidneyorinfectiouscomplications).Thesetestsarebbeyondthescopeofthis
bookletbecausetheyarenotusedroutinelly.

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LABORATORYTESTS
1. Completebloodcount(CBC)givesinformationaboutthepresenceor
absenceofanemia,and/orlowwhitecellcount,and/orlowplateletcount.
2. Chemistry/MetabolicPanelprovidesthebloodcalciumlevel;serum
creatinineasameasureofkidneyfunction;andliverfunctiontestresults.
3. SerumProteinElectrophoresis(SPEP)assessestheamountofabnormal
(monoclonal)protein.
4. Urine Protein Electrophoresis (UPEP)showstheamount ofmonoclonal
proteinintheurine.Patientsmustcollecturinefor24hoursanditisthen
senttothelabforUPEP.Onlymonoclonallightchains,notheavychains,are
found inurine.Approximately 30% ofpatients havelightchainproteinin
theirurineas well asheavy and light chainsin the blood.Approximately
10% of patients have myeloma cells that produce only light chainsandno
heavychains.
5. Immunofixation(IFE)providesinformationastothepresenceorabsence
ofamonoclonalproteinaswellasthetypeofmyelomaprotein;i.e.,heavy
chain(G,A,D,orE);and/orlightchain(kappaorlambda).
6. Quantitative Immunoglobulins shows the total amount of IgG, IgA, and
IgM,bothnormalandabnormal(spike).
7. Freelite®test(serumfreelightchainassay,SFLC)isusedtomeasurethe
numberof freekappaor free lambdalightchains (fragmentsof the
monoclonalprotein)ifitisnotpossibletoquantifyheavychainswithserum
protein electrophoresis, or light chains with urine protein electrophoresis.
Somepatients'myelomacellssecretevery little orno monoclonal protein
thatcanbedetectedwithSPEPorUPEP;themajorityofthesepatientscanbe
testedadequatelywiththeserumfreelightchainassay.
8. Routine urinalysis can showthepresence ofproteinand/or may indicate
evidenceofkidneydamageorinfection.
9. UrineImmunofixation(urineIFE)asforIFEintheserum,indicatesboth
thepresenceorabsenceaswellasthetypeofmonoclonalprotein.


IMAGINGSTUDIES
1. Xraysarethefirstimagingstudydonetosearchformyelomacausedbone
damage.Afullskeletalxraysurveyisneededtodemonstratelossor
thinningofbone(osteoporosisorosteopenia),holesinbone(lyticlesions),
and/orfractures.Xraysaresimpletodo.Theirlimitationsarethat30%or
moreofthebonemustbemissingbeforexraycanrevealthedamage,and
thatdamagetoaboneshowsuppermanentlyonxray,evenifthereisno
longeranyactivemyeloma.
2. CTscanorCATScan(ComputerizedAxialTomography)usesxray
technologytocreateathreedimensionaldigitalimageofthebody.Itisa
muchmoreprecisestudythanxray,andcanprovideclear,detailedimages

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ofbone.Downsidesincludelimitedcoverageofthebody,andthepossible
needtousecontrastagentsthatcanposeproblemsformyelomapatients
withkidneydysfunction.
3. MRIscan(MagneticResonanceImaging)isanoninvasivestudythatuses
magneticenergytoproduceadetailedtwoorthreedimensionalimageof
structuresinsidethebody.Itisusefulforimagingplasmacytomas(tumors
formedfrommassingofmyelomacellsinsideoroutsidethebonemarrow);
infiltrationofthebonemarrowbyclumpsofmyeloma;andcompressionof
thespinalcord.Althoughitisusefulfordetectingnewdiseaserapidly,there
isa9monthormorelagtimebeforeanMRIwilllooknormalafteranareaof
myelomahasbeensuccessfullytreatedandisnolongeractive.Itisan
expensivestudycomparedtoxrayandCT,takes3060minutestocomplete,
andcoversalimitedareaofthebody.
4. PETscan(PositronEmissionTomography)requiresthatapatientbe
injectedwithasugarfluorinecompound(FDG,orfluorodeoxyglucose)that
istakenupbythebody'sactivelymultiplyingcells.Whenthebodyis
scanned,theareaswiththehighestconcentrationsoffluorine"glow,"
revealing"hotspots"whererapidmetabolismcanindicateareasofcancer
cells.Thisscancoversthewholebody,isverysensitiveindetectingpotential
tumoractivity,andistheonly"realtime"imagingstudy.Itisavaluabletool
forpatientswhodonotsecretemonoclonalproteinandwhosemyelomais
thereforedifficulttoassess,andforsituationswherexray,MRI,andCTdo
notprovideenoughinformationaboutpotentialnewdisease.Itis,however,
expensiveandtimeconsuming,requiring90150minutestoperform.
5. PET/CT combinesPETandCT scans inoneimagingstudy, providing
information bothaboutpast damageandcurrentcancer activity,thus
enablingthedoctortostudychangesovertime.Itisahighlyaccuratestudy,
butlikestandardPET,itisexpensiveandtimeconsuming.
6. Bonedensitytestingishelpfulformonitoringthebonesofpatientswho
havediffusethinning(osteopeniaorthemoresevereconditionosteoporosis)
ofthebonecortex.Improvementwiththickeningofbone(increaseddensity)
occurswiththebenefitofusingbisphosphonatetherapy.
PATHOLOGYSTUDIES
1. Bonemarrowbiopsyisperformedtoassessthepercentageofmyeloma
cellsinthebonemarrowandtodeterminehowmuchtheydifferfrom
normalplasmacells.Specialtestingisdoneonthebonemarrowbiopsy
sampletoassessprognosisbasedonchromosomalabnormalities.(See
"GenetucStudiesbelow.")
2. Othertissuebiopsymaybeperformedifthehematologist/oncologistis
concernedaboutamyloidosisorextramedullary(outsidethebonemarrow)
disease.

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GENETICSTUDIES
1. MetaphaseCytogenetics(karyotyping)isatestinwhichthebonemarrow
biopsyspecimenisplacedintoaspecialdishandallowedtogrowinthe
laboratory.Cellsarelatertakenfromthegrowingsampleandstained.The
laboratoryspecialistusesamicroscopetoexaminethesize,shape,and
numberofchromosomesinthecellsample.Thechomosomescanonlybe
exninedinthiswayifthecellsareundergoingactivecelldivision
(metaphase).Thestainedsampleisphotographedtoprovideakaryotype,
whichshowsthearrangementofthechromosomes.Certainabnormalities
canbeidentifiedthroughthenumberorarrangementofthechromosomes.
Thistestisparticularlyvaluableforidentifyinghigherthanaveragerisk
myelomainpatientswithfewerthantwocopiesofeachchromosome
(hypodiploidy)andinthosewithdeletionofchromosome13duringcell
division.
2. FluorescenseInSituHybridization(FISH)providesresearcherswitha
waytovisualizeandmapthegeneticmaterialinanindividual'scells,
includingspecificgenesorportionsofgenes.Thisisimportantfor
understandingavarietyofchromosomalabnormalitiesandothergenetic
mutations.Unlikemetaphasecytogenetic,FISHdoesnothavetobe
performedoncellsthatareactivelydividing.Itisusefulfordefininghigh
riskmyelomainpatientswithcertainchromosomaltranslocationsand
deletions,especiallyt(4;14)and17p,inwhichthetoppartofchromosome
17islost(missing).

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