This summer I am sharing guest blogs from a variety of experts. This week’s blog is the second in a multi-part series about multiple myeloma from my colleague Dr. Margaret Henderson who has a Doctor of Pharmacy degree from the University of Colorado.
–Dr. Stephen Vogt
Welcome to the second installment in a 5-part patient education series on multiple myeloma. Multiple myeloma, a form of cancer affecting the bone marrow, is diagnosed in approximately 30,000 Americans each year. In this disease, malignant plasma cells (which are a type of white blood cell) start growing out of control and can create multiple tumors in the bones. The cancerous plasma cells can also crowd out other cells in the bone marrow, leading to lower blood counts and anemia.
HOW IS MULTIPLE MYELOMA DIAGNOSED?
Generally patients present to a healthcare provider or emergency department with unexplained symptoms, such as renal dysfunction, anemia, extreme bone pain, and/or fracture, and may receive tests to determine the cause. Tests available to assist in the diagnosis of multiple myeloma include blood or urine tests, bone marrow biopsy, and imaging tests. There is no single test that can diagnose multiple myeloma, but rather several tests are used in combination to reach a diagnosis.
Blood and Urine Tests: These tests are minimally invasive and easy to obtain. M-protein can be found in the blood or urine tests of almost all patients with multiple myeloma. Additionally, in some patients, free light chains (kappa and lambda) may be secreted into the blood or urine. It is important to note, however, that not all patients who test positive for M-proteins in the blood or urine have multiple myeloma. Additional testing is needed to confirm the diagnosis.
Bone Marrow Biopsy: This is a collection of a small sample of bone marrow, usually taken from the hip, but may be taken from other areas as multiple myeloma can affect the marrow of some bones, but not others. Bone marrow is extracted using a needle and syringe. The needle is inserted into the area of collection, and may be inserted into several areas to ensure enough bone marrow is collected. Bone marrow biopsy is useful in the diagnosis of multiple myeloma because it looks for a high percentage of plasma cells in the bone marrow (more than 10%). The excessive number of plasma cells in the bone marrow is a hallmark indicator of multiple myeloma.
Imaging: X-rays may be used in patients to look for bone erosion, thinning of the bone, and/or fractures. Many patients present for treatment because of bone pain and/or fractures.
Genetic and Chromosomal Tests: These tests are useful in determining the patient’s stage and risk category for multiple myeloma.
The diagnosis of multiple myeloma is made when:
- A bone marrow biopsy reveals plasma cells accounting for 10% or higher of all cells present in the bone marrow or the presence of a plasmacytoma
AND at least one of the following:
- High blood calcium levels
- Poor kidney function and/or kidney failure
- Severe bone damage
- Increase in one type of light chain in the blood, so that one type is 100 times more common than the other
- A bone marrow biopsy reveals plasma cells account for 60% or higher of all cells present in the bone marrow
The following weeks of this 5-part series will cover the staging and prognosis of this form of cancer, its treatment, and treatment complications.
Rajkumar SV. Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics). In: UpToDate, Waltham, MA. (Accessed on June 9, 2017)