What biomarker tests are recommended for Multiple Myeloma

Biomarker Tests Recommended for Multiple Myeloma

When you're diagnosed with multiple myeloma, your care team will order several biomarker tests to understand your specific disease and plan your treatment. These tests measure proteins and genetic markers that tell doctors important information about your myeloma cells.

Key Protein Biomarkers

M Protein (Monoclonal Protein) Your myeloma cells produce abnormal antibodies called M proteins. According to the NCCN Guidelines, doctors measure M protein levels using two tests:

• SPEP (Serum Protein Electrophoresis) - measures the amount of M protein in your blood
• SIFE (Serum Immunofixation Electrophoresis) - identifies which type of M protein you have (such as IgG kappa or IgA lambda)

These tests are crucial because M protein levels reflect how much disease you have and how well treatment is working. You'll have these repeated regularly to monitor your response.

Free Light Chain (FLC) Assay This test measures extra light chain proteins circulating in your blood. According to NCCN Guidelines, the FLC assay is particularly important for:

• Diagnosing light chain myeloma (when myeloma cells produce only light chains)
• Monitoring disease progression
• Documenting complete remission (the FLC ratio is required for this)

The FLC ratio (the balance between kappa and lambda light chains) is an independent risk factor for disease progression.

Immunoglobulin Levels Your blood is tested for total antibody levels (IgA, IgG, IgM, and sometimes IgD and IgE). Abnormal levels indicate myeloma.

Kidney and Organ Function Biomarkers

According to NCCN Guidelines, these tests assess organ damage from myeloma:

• Serum creatinine and BUN - measure kidney function (myeloma damages kidneys)
• Albumin - a protein made by the liver; low levels may indicate advanced myeloma
• Calcium - elevated levels are common in myeloma
• Lactate dehydrogenase (LDH) - reflects tumor cell characteristics and prognosis
• Beta-2 microglobulin - a protein that reflects tumor burden and is used for risk stratification

Genetic/Chromosomal Biomarkers (FISH Testing)

This is one of the most important tests for your treatment planning. According to NCCN Guidelines, your bone marrow cells are tested for specific chromosomal abnormalities using FISH (Fluorescence In Situ Hybridization). Your doctor looks for:

Standard FISH Panel:

• del(13) - deletion of chromosome 13
• del(17p13) - deletion of chromosome 17 (high-risk feature)
• t(4;14) - translocation between chromosomes 4 and 14 (poor prognosis)
• t(11;14) - translocation between chromosomes 11 and 14 (lower risk)
• t(14;16) - translocation between chromosomes 14 and 16 (poor prognosis)
• t(14;20) - translocation between chromosomes 14 and 20 (poor prognosis)
• 1q21 gain/amplification - extra copies of chromosome 1 (linked to aggressive disease)
• 1p deletion - loss of part of chromosome 1

TP53 Mutation Testing NCCN Guidelines recommend next-generation sequencing (NGS) to assess for TP53 mutations, which are associated with high-risk disease.

Why This Matters: These chromosomal abnormalities help your doctor determine whether your myeloma is standard-risk or high-risk, which directly influences which treatments are recommended and how aggressively they'll treat you.

Urine Biomarkers

According to NCCN Guidelines, your 24-hour urine is tested for:

• Total protein - measures disease burden
• UPEP (Urine Protein Electrophoresis) - measures M protein in urine
• UIFE (Urine Immunofixation Electrophoresis) - identifies the type of M protein in urine
• Free light chains - high levels indicate greater risk for kidney damage

Additional Biomarkers (Used in Certain Cases)

NT-proBNP/BNP According to NCCN Guidelines, this heart-related biomarker is recommended at baseline because some myeloma treatments can affect heart function.

Blood Viscosity This measures blood thickness. High M protein levels can make blood very thick (hyperviscosity), which can cause serious complications.

How These Tests Guide Your Care

These biomarkers serve multiple purposes:

1. Diagnosis - confirm you have myeloma
2. Risk stratification - determine if your myeloma is standard or high-risk
3. Treatment selection - guide which drugs your doctor recommends
4. Monitoring - track how well treatment is working (M protein and FLC levels should decrease)
5. Prognosis - help predict how your disease may behave

Questions to Ask Your Care Team

• Which biomarkers do I have, and what do they mean for my specific situation?
• Are my chromosomal abnormalities standard-risk or high-risk?
• How often will these tests be repeated?
• What changes in my biomarker levels would indicate the treatment is working?
• Will my biomarker results affect my treatment options?
• Can my tissue samples be saved for additional testing if needed?

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.

Sources: NCCN Guidelines for Multiple Myeloma (Version 3.2026); NCCN Guidelines for Patients: Multiple Myeloma (2025)