Multiple myeloma how is it diagnosed

A skeletal survey, or whole body X-ray survey, is typically employed to detect osteolytic lesions. Magnetic resonance imaging MRI short-tau inversion recovery STIR is a more sensitive investigation, and may be used to identify lytic lesions in suspicious cases when the skeletal survey fails to yield a diagnosis.

Figure 2. Thoracic spine x-ray demonstrating multiple wedge compression insufficiency fractures typical of myeloma. By definition, patients with MGUS and smouldering multiple myeloma are asymptomatic. The condition may become apparent when routine blood tests reveal an elevated total protein and globulin, and subsequent serum electrophoresis demonstrates a monoclonal paraprotein.

These patients may ultimately progress to symptomatic myeloma and require careful monitoring. Evaluating a patient with suspected multiple myeloma involves establishing evidence of a monoclonal paraprotein with serum electrophoresis EPG and immunofixation, together with an FLC analysis. A serum FLC analysis must always be requested, as a small percentage of patients do not have measurable disease on serum EPG and immunofixation and would be otherwise missed.

Full blood count and film, electrolytes including urea and creatinine, calcium, magnesium and phosphate analysis should always be performed to detect evidence of end-organ disease. Imaging to detect bony lesions, typically in the form of a skeletal survey, is mandatory. A referral to a haematologist should be made in order to obtain a bone marrow aspirate and trephine, and to guide further management Table 2. Diagnosis of multiple myeloma is based on the International Myeloma Working Group guidelines Table 3.

Prognosis is commonly evaluated using the International Prognostic Index, which divides patients into three stages. Stage II disease, for patients who do not fulfil the criteria for the other stages, has a median survival of 44 months.

In MGUS, the type and quantity of paraprotein and the presence of abnormal serum FLCs can determine the risk of transformation to overt multiple myeloma. These parameters are used to help determine the frequency of monitoring. Symptomatic myeloma usually requires immediate treatment Figure 3. For those younger than 65 years of age, or those aged 65—70 with few comorbidities, autologous stem cell transplantation is the standard of care.

Patients typically receive 3—6 cycles of induction treatment, aiming to achieve a complete or near complete response, prior to receiving their transplant. There have been significant advances in the choice of induction agents and several new agents that have improved responses in multiple myeloma are now available.

The best results appear to be achieved with a combination of steroids, cytotoxic chemotherapy such as cyclophosphamide or doxorubicin , and a novel immunomodulatory agent eg. The choice of novel agent is often determined by comorbidities and side effect profile; bortezomib is preferred in the setting of renal impairment or advanced disease, while lenalidomide is preferred in the setting of peripheral neuropathy.

Following transplant, patients are often offered maintenance thalidomide, with or without prednisone, for approximately 12 months.

Despite a clear improvement in progression-free survival, this strategy may be poorly tolerated due to medication side effects and adversely impact on patient quality of life. Those ineligible for transplant may be treated with a combination of steroids, a cytotoxic agent such as cyclophosphamide and thalidomide or bortezomib.

The role of maintenance therapy following induction treatment remains unclear in this group. Bisphosphonates are a critical adjunctive therapy employed in symptomatic myeloma, and offer a clear reduction in pathological vertebral fractures, pain and other skeletal events. Intravenous monthly zoledronic acid has also been reported to improve overall survival.

Patients should have all necessary dental work completed prior to commencing bisphosphonates to minimise the risk of ONJ. Treatment for those with MGUS and smouldering myeloma consists of watchful waiting, with serial monitoring of the paraprotein and frequent assessment for the development of myeloma-related organ or tissue impairment.

Australian guidelines suggest monitoring of MGUS occur 3—12 monthly, depending on the individual patient risk. Matt, 44 years of age, presented to his general practitioner with a two-week history of sudden onset lower back pain. X-ray revealed a thoracic vertebral crush fracture, and he was prescribed analgesia.

He was previously well with no significant medical history, including no history of corticosteroid use, and denied a history of trauma. He presented to the emergency department four weeks later with ongoing back pain, and was prescribed additional analgesia and discharged.

He re-presented to the emergency department within a week due to uncontrolled pain, and blood tests were taken for the first time. A serum electrophoresis was subsequently requested, showing an IgAK monoclonal band, and bone marrow biopsy confirmed a diagnosis of myeloma. Multiple myeloma can present a difficult diagnostic issue, as there are a wide variety of presenting symptoms. Establishing the diagnosis rests on identifying a monoclonal paraprotein in the serum and confirming the presence of myeloma-related organ or tissue injury, followed by haematology referral to establish evidence of bone marrow plasmacytosis, and for future management.

With the introduction of novel immunomodulatory agents and proteasome inhibitors, newly diagnosed patients are enjoying a longer life expectancy than their historical peers. However, the role of the general practitioner is still crucial in helping to make an early diagnosis, allowing patients to be identified and treated without potentially harmful delays. Competing interests: None.

Provenance and peer review: Commissioned; externally peer reviewed. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis Sometimes multiple myeloma is diagnosed when your doctor detects it accidentally during a blood test for some other condition. Tests and procedures used to diagnose multiple myeloma include:.

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Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Kaushansky K, et al. In: Williams Hematology. McGraw Hill; Accessed Sept. Ferri FF. Multiple myeloma. In: Ferri's Clinical Advisor Elsevier; Niederhuber JE, et al. Multiple myeloma and related disorders. In: Abeloff's Clinical Oncology.

National Comprehensive Cancer Network. Plasma cell neoplasms including multiple myeloma treatment PDQ — Patient version. National Cancer Institute. Distress management. Warner KJ. Allscripts EPSi. Mayo Clinic. June 24, Russell SJ, et al. Remission of disseminated cancer after system oncolytic virotherapy. Mayo Clinic Proceedings. Multiple myeloma adult.

Mayo Clinic; Kumar S, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncology. Cavo M, et al. Rajkumar SV, et al. Program genealogies: Myeloma at Mayo. For example, we may retain certain information if we need to do so to comply with an independent legal obligation, or if it is necessary to do so to pursue our legitimate interest in keeping the Website safe and secure. If you have any complaints regarding our privacy practices, you have the right to lodge a complaint with your national data protection authority i.

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Once submitted, a member of our team will contact you as soon as possible. High impact topic videos, or HITs, are videos that use engaging animations and narration to present information on topics of importance to myeloma patients and their caregivers. Presented in a patient-friendly manner and viewable on iPads, tablets, and smartphones, these HITs bring to life and explain concepts that can sometimes be difficult for patients and caregivers to understand.

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Continued use of our Website, following notice of such changes shall indicate your acknowledgement of such changes and agreement to be bound by the terms and conditions of such changes. Meryl Zausner has over 35 years of management experience across the pharmaceutical and consumer products industries.

Meryl was instrumental in creating the blueprint for the successful Novartis Oncology Business Unit and engineering the launch of the first Novartis shared services organization. For much of her corporate career, Meryl worked at Novartis AG, the Swiss pharmaceuticals company, in roles of increasing responsibility across diversified businesses.

Acknowledging her strong leadership and broad achievements, Novartis selected Meryl to train and serve as a certified Executive Coach to senior executives, a position she held from May until her retirement at the end of June Here, she supports myeloma patients in a variety of ways from triaging calls, to educating patients on their myeloma, labs and test results, and coordinating with research and management to implement integral changed and streamline processes for access to new treatments.

Brittany earned her Bachelor of Science in Nursing at the University of Delaware, where she had the opportunity to be a student nurse for a private physician for over a year.

She is responsible for overseeing the daily operations of the PNC and guiding myeloma patients through their disease journey. Prior to her career in nursing, she worked in marketing and advertising in the real estate industry for 4 years.

With over a decade of experience in enterprise software, Adrian is widely respected for being a boots-on-the-ground leader with a track record of driving growth. He has also served as an advisor for Harvard Business School's Kraft Precision Medicine program, using his experience with direct-to-consumer teams to help nonprofits accelerate precision medicine efforts via direct-to-patient engagement. He currently lives in San Francisco, where he loves to exercise and explore the outdoors.

Grace has been a registered nurse for more than 30 years. She spent the last 28 years working at one of the largest myeloma programs in the U. She was fortunate to have spent her career at UAMS under the tutelage of one of the most well known myeloma physicians, Dr. Bart Barlogie. She is also a board certified medical-surgical registered nurse RN-BC. She brings over 23 years of development experience to this position.

Flinn spent over a decade in development at Mayo Clinic in Rochester, MN and in Jacksonville, FL, where she oversaw the stewardship of top-level benefactors and served as a major gift officer. Her additional accomplishments include successfully climbing Mt. Kilimanjaro in as a member of Survivor Summit and skydiving.

Greg is a graduate of Cornell University, with a B. He resides in Irvington, NY with his wife and two sons. Kristen has been a registered nurse for a little over 20 years.

Sarah has been a registered nurse for the past five years, specializing in Hematology Oncology and Bone Marrow Transplant. She has spent over ten years in the Oncology field and started her career at Yale New Haven Hospital. She earned her nursing degree from St. Labkoff is a global medical leader with a track record of developing cutting edge strategies towards new healthcare delivery models.

He has demonstrated success in the convergence of medicine, life sciences and policy across disparate organizations including government, non-government organizations NGOs , health plans and academic institutions. He joined the MMRF after a year career in healthcare informatics for the Life Science Industry where he worked on a wide array of issues ranging from the secondary uses of healthcare data for Life Sciences, health information technology policy, Big Data and analytics and medical affairs.

Prior to Purdue he was Vice President of Life Sciences at Intelligent Medical Objects focused on leveraging medical vocabularies, ontologies, and terminologies for Life Science customers. Previously, Dr. He completed a post-doctoral fellowship at Harvard Medical School and Massachusetts Institute of Technology in Medical Informatics where he focused on the uses of point-of-care computing and mHealth.

Kathy has more than two decades of experience in the pharmaceutical industry, previously holding senior positions at G. Searle and Merck. Since founding the MMRF in , Kathy has become a widely respected leader in establishing innovative, collaborative research models in the areas of tissue banking, genomics, and clinical trials. These models are dramatically accelerating the pace at which lifesaving treatments are brought to patients and are building an end-to-end solution in precision medicine.

Today, she is recognized as a pioneer of precision medicine, a champion of data sharing, and a strong advocate for patient engagement.

Under her leadership, the HBS Kraft Precision Medicine Accelerator convenes best-in-class leaders from science, business, and technology to identify and solve challenges slowing the advancement of precision medicine. The HBS Kraft PM Accelerator disseminates best practices and models to overcome these challenges, and ultimately enables faster adoption of high-impact innovations. Learn more about Kathy. Erin is the Manager of the Patient Navigation Center. She is passionate about helping to guide myeloma patients and to further research for the myeloma community.

She has been a registered oncology nurse for ten years. Prior to becoming an oncology nurse, Erin was a healthcare representative for Pfizer and Sanofi-Aventis. Christopher Williams was named Vice President of Business Development at the MMRF in , responsible for business development, partnership and joint venture efforts for the foundation. He is a business development leader with a strong scientific background, specializing in the pharmaceutical and diagnostics space.

Most recently he served as the VP of Business Development at WaveSense where he was in charge of their US commercialization strategy and product expansion, as well as being responsible for overseeing their strategic partner relationships. With PerkinElmer, as the Market Segment Leader in Oncology, he had responsibility for their cancer diagnostic products including strategy, launch activities, external presentations and marketing execution.

Steve Varley joined the MMRF team in and is responsible for the fundraising efforts of the organization. Before joining Citigroup, Ms. Gilman has over 20 years of experience designing and executing events and initiatives that generate revenue. She received her B. Karen has worked with the consortium sites and pharma companies to launch nearly multi-center clinical trials including the first-ever myeloma platform trial, MyDRUG. She has co-authored a number of peer-reviewed abstracts and publications on the MMRF Precision Medicine Model and identifying knowledge gaps and opportunities to improve patient empowerment and engagement in optimizing their own outcomes.

Prior to joining the MMRF in , she was a consultant in the Healthcare Practice of Datamonitor, a global market research and business intelligence company. She previously worked in healthcare public relations at Burson-Marsteller and the Chandler Chicco Agency, following a postgraduate internship at the Department of Justice, Antitrust Division. Most recently he was the Vice President of Finance and Corporate Controller of Aptuit, LLC, a global contract research organization providing integrated early discovery to mid-phase drug development services in the pharmaceutical industry.

Rob has over 20 years of leadership experience in the private and public sectors, holding managerial positions in the renewable energy, private equity, Internet and technology industries, including Davenport Newberry, Oak Investment Partners and INT Media Group. Giusti worked as a Chief Executive Officer, leader, executive and entrepreneur for over 30 years; he has founded, managed and led a variety of businesses.

Early in his career, Mr. Giusti worked as an executive for GE where he held a number of management positions with a wide range of responsibilities. Giusti has worked closely with the MMRF since its founding in Sinai Tisch Cancer Institute. First, they are investigating immunologic therapies with a focus on using cutting edge genomic and immunologic assays to map the interaction between myeloma and the immune system in the tumor microenvironment.

These projects illuminate the mechanisms of action of novel immune therapies in both laboratory models and clinical trials and will inform the design of rational combinations. This program has a special focus on immunologic therapy in the setting of autologous stem cell transplantation for myeloma.

Second, Dr. They demonstrated that type I MAGE plays a critical role in conferring resistance to chemotherapy and inhibition of apoptosis in myeloma cells through regulation of Bcl-2 family proteins and the tumor suppressor p She decided to pursue the treatment plan that had a more holistic approach, and if it came to a point in which she needed a transplant, she wanted to pick the environment that felt the most nurturing. Randi knew that there were many steps and lifestyle changes that she had to make towards her healing.

Her diagnosis affected her in medicinal, environmental, holistic, mental, personal and spiritual ways. She continues to maintain her super healthy lifestyle and practices good dietary habits. It was difficult for Randi to believe that she had cancer, as she had to learn to recreate herself and was grateful to be alive. Randi is very active in the multiple myeloma community and participates in races all over the country.

She told her doctors that she was willing to do her homework to propose to them ways in which she could slowly return to participating to a certain degree in some of her active hobbies and most importantly, she has learned to listen to her body. I was diagnosed with multiple myeloma seven years ago at the age of It started with pain in my hip that was quickly diagnosed as cancer. This time period can be filled with uncertainty, but the thing that has always helped, whether it was the day of the diagnosis or currently, is the importance of having people in your life that are there for you.

I was diagnosed with Multiple Myeloma when I was 26 years old. I was a bit lost at first because I was very young when I received this diagnosis, but I soon realized that everyone experiences it differently. I am very motivated to share my experiences with others battling this disease and hope to empower other patients during their journey.

I have been married for 35 years, with two grown sons ages 29 and 26 and am fortunate to have a very strong support system. I feel that the biggest challenge is adapting to a label of being a cancer patient. I stay positive with all the things I am able to do and love such as cooking, painting, drawing, snow skiing and cycling. Craig C. Patti has smoldering myeloma and had no signs or symptoms of her disease when she was diagnosed. During her annual physical her bloodwork came back abnormal, so her physician ordered further testing.

Patti is now in a study where some of the smoldering patients receive Revlimid for treatment and the remaining patients remain under observation without treatment. The test is to see if the medication will help eradicate the smoldering Multiple Myeloma.

As a result of the study, Patti now gets blood tests every month and every year she will get a PET scan and bone biopsy to keep an eye on the status of her Multiple Myeloma.

In , Tricia was dealing with extreme fatigue. Her primary care physician ordered routine bloodwork and found that she was severely anemic. She was then sent to a local hematologist who did a bone marrow biopsy. At this time she was diagnosed with smoldering myeloma after receiving a second opinion.

Tricia participates in MMRF events in hopes of furthering multiple myeloma research. She enjoys sharing her personal experience with other myeloma patients and is looking forward to helping others understand this disease better and find resources for them that will help with their personal myeloma journey. My husband, JP, was diagnosed with multiple myeloma six years ago at the age of We do whatever we can to support the MMRF and to keep a positive mindset about our situation.

It has been a journey from day one, but I feel we are confident going forward. It revealed that she had low platelets and was anemic. At the time, Carmen was diagnosed with smoldering multiple myeloma, as she did not meet the criteria to be diagnosed with active multiple. Carmen strives to stay positive and maintain a healthy and active lifestyle. She has persevered and embraces the changes that her diagnosis has caused in her life.

His healthcare team embraced his determination to educate himself, which gave him additional confidence in his doctors. Andrew has kept a positive outlook and is self-motivating. One motivating factor he had was retirement; although, he only wanted to semi-retire. He remains an active grandfather to his two young grandsons and helps his daughter by babysitting them.

He feels that his multiple myeloma journey has made him a better person in that he is more compassionate and understanding. Jessie is determined to not let her diagnosis define her and dominate her life; therefore, she has taken control of the situation by continuing her research and education on her diagnosis and learning the importance of practicing self-awareness and self-advocacy for her own health.

She has become dedicated in her efforts to incorporate being health-conscious in her lifestyle. Now, she's revisiting this and learning how to reinvent herself and the lifestyle she plans to lead. Jeffery stresses the importance of staying motivated and positive.