NCCN Guidelines for Patients
Multiple Myeloma, Version 1.2014
Tests for myeloma
At the lab
The pathologist may do several tests on the biopsy
samples, such as:
• Genetic testing for abnormal genes. These
tests are done in three parts. Bone marrow
cells are grown to make the cells divide.
Next, the dividing cells can be examined by
karyotyping, which looks at a map (karyotype)
of the chromosomes in the myeloma cells.
Myeloma cells can also be examined with
a test called FISH (
ybridization). FISH uses probes that attach
to certain parts of the chromosomes known to
be affected in myeloma. The newest testing
looks for certain genes that may be turned on
or turned off in myeloma cells.
• Staining of marrow and fat pad for amyloid.
Amyloid is an abnormal protein found in
people with myeloma cells that make too
many light chains. The free light chains
combine with substances in the blood, which
causes them to clump together to make
amyloid. Amyloid can be deposited in organs
such as the heart and kidneys. The buildup of
amyloid, called amyloidosis, can cause organ
damage. To check for amyloid, the pathologist
can test bone marrow or fat from just under
the skin of the belly, called the fat pad.
• Multiparameter flow cytometry is another
test that measures the amount of myeloma
cells in the bone marrow. Doctors use this
test to judge the risk of progression to active
myeloma in patients without symptoms. A high
number of myeloma cells is a sign that the
myeloma will likely progress.
• Bone marrow immunohistochemistry
measures the number of myeloma cells.
• Plasma cell labeling index is a test that shows
what percentage of the myeloma cells are
dividing and how fast they are doing it. Cells
that are dividing quickly are a sign of cancer
that will spread fast.
Imaging tests take pictures (images) of the inside of
your body. These tests are often easy to undergo.
Before the test, you may be asked to stop eating or
drinking for several hours. You also should remove
any metal objects that are on your body. For some
imaging tests, a contrast dye may be injected into
your vein to make the pictures clearer. However, this
contrast dye can cause more damage to frail kidneys,
so it must be avoided in any person with multiple
myeloma. The types of imaging tests used for multiple
myeloma are described below.
A bone survey—also called a skeletal survey—is a
test that uses a set of x-rays to take pictures of your
entire skeleton. A bone survey is done to check for
broken or damaged bones caused by myeloma.
Bone densitometry uses x-rays to make pictures that
show how strong or thin bones are. This test may be
used to decide if bone-strengthening medications,
called bisphosphonates, may be a good option for
A CT (
omography) scan takes many
pictures of a body part from different angles using
See Figure 2.2.
A computer combines all the