What tests do I need right after being diagnosed with Multiple Myeloma

Tests After a Multiple Myeloma Diagnosis

After you're diagnosed with multiple myeloma, your care team will order several important tests. These aren't just to confirm the diagnosis—they help determine how advanced your disease is, plan your treatment, and check if you're a candidate for a stem cell transplant. Let me walk you through what to expect.

Blood Tests (Core Testing)

According to the NCCN Guidelines for Patients: Multiple Myeloma, these blood tests are essential:

Complete Blood Count (CBC) with Differential

• Measures your red blood cells, white blood cells, and platelets
• Helps identify anemia (low red blood cells) or infection risk (low white blood cells)

Immunoglobulin Levels

• Measures antibodies (IgA, IgG, IgM) in your blood
• Shows if any antibody type is abnormally high

M Protein Tests (two types):

• SPEP (Serum Protein Electrophoresis): Measures the amount of abnormal myeloma proteins in your blood
• SIFE (Serum Immunofixation Electrophoresis): Identifies which type of M protein you have (like IgG kappa or IgA lambda)—this is important for tracking your disease

Free Light Chain Assay

• Measures extra light chains (protein pieces) in your blood
• Especially important if your myeloma produces only light chains

Blood Chemistry Panel

• Tests kidney function (creatinine, BUN), calcium levels, and liver function
• Myeloma can damage kidneys and affect bone health, so these are critical

Urine Tests

24-Hour Urine Collection

• Measures total protein and M proteins in your urine
• Shows if myeloma proteins are damaging your kidneys
• Helps measure your overall disease burden (how much cancer is in your body)

Bone Marrow Biopsy and Aspiration

This is the test that confirms myeloma. According to NCCN guidelines:

• A small sample is removed from your pelvic bone (near your hip)
• The sample is examined under a microscope to count abnormal plasma cells
• A diagnosis requires at least 10% abnormal plasma cells

Lab tests on the bone marrow sample include:

• Immunohistochemistry: Identifies the number and type of myeloma cells
• Flow Cytometry: Detects abnormal plasma cells using special markers
• FISH (Fluorescence In Situ Hybridization): Looks for genetic abnormalities in your myeloma cells that affect prognosis and treatment planning

The FISH panel specifically checks for these important genetic markers:

• Deletions of chromosome 13 or 17p
• Translocations (swaps) between chromosomes 4 and 14, 14 and 16, or 14 and 20
• Extra copies or deletions of chromosome 1
• Mutations in the TP53 gene

These genetic findings help your doctor understand if your myeloma is standard-risk or high-risk, which affects treatment decisions.

Imaging Tests

PET/CT Scan (strongly recommended)

• Combines two types of imaging to show where active myeloma is located throughout your body
• Uses a radioactive tracer (usually FDG) that makes myeloma cells appear bright
• Shows both bone damage and areas where myeloma cells are active

Alternative imaging options:

• Low-dose CT scan: Shows lytic bone lesions (cracks in bones)
• MRI: Particularly useful for distinguishing multiple myeloma from smoldering myeloma and for examining soft tissues
• Bone survey: X-rays of your entire skeleton (less commonly used now)

Additional Tests (If Needed)

According to NCCN guidelines, these tests are only done in specific situations:

• Blood viscosity test: If you have very high M protein levels (can cause thick blood)
• Echocardiogram: Heart ultrasound if certain treatments are planned
• Light chain amyloidosis biopsy: If there's concern about amyloid protein buildup in organs

Why This Matters

These tests serve three critical purposes:

1. Confirm diagnosis - Bone marrow biopsy proves you have myeloma
2. Determine disease stage - Blood and urine tests show how much disease is present
3. Guide treatment - Genetic testing (FISH) and other results help your doctor choose the best treatment approach and determine if you're eligible for a stem cell transplant

Important Next Step

The NCCN Guidelines emphasize: Getting a second opinion from a myeloma specialist is normal and recommended. Treatment decisions made early on seriously affect later options, so seeking out a specialist's review of your test results is a good use of time.

Questions to Ask Your Care Team

• How soon will I get all my test results?
• Will my biopsy tissue be saved so it can be sent for additional testing if needed?
• What do my specific genetic test results (FISH) mean for my treatment options?
• Am I eligible for a stem cell transplant based on these tests?
• Can I get a second opinion from a myeloma specialist?

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