NCCN Guidelines for Patients
Multiple Myeloma, Version 1.2014
Multiple myeloma testing
It measures calcium to test for bone damage. It also
measures LDH, albumin, and beta-2 microglobulin to
assess for myeloma severity.
The other blood tests as well as the urine tests
are used to check for and measure M-proteins.
Very often, the serum free light chain assay along
with SPEP and SIFE can detect multiple myeloma
correctly when it is present. The serum free light
chain assay is also useful for cancer prognosis and
follow-up of amyloidosis and oligosecretory myeloma.
A bone marrow aspiration and biopsy is
recommended to confirm a diagnosis of multiple
myeloma. Bone marrow immunohistochemistry
shows if M-proteins are present, and multiparameter
flow cytometry counts the number of myeloma cells.
Genetic testing of bone marrow can find changes in
genes linked to myeloma. Genetic testing may show
if genes from two cells have been switched, if genes
are missing, or if too many copies of a gene have
Possible other tests
In addition to the initial tests described above, a few
more tests may be useful for some people. MRI, CT,
or PET/CT may be useful to view areas of your body
where symptoms are present. These imaging tests
may show cancer or if you have bone damage. Bone
densitometry testing can be used to assess bone
strength to see if you need drugs that prevent or treat
If imaging tests show a solitary plasmacytoma, it
must be confirmed with a tissue biopsy. Staining of
the bone marrow and fat pad checks for amyloid—
an abnormal protein found in people with myeloma
cells that make too many light chains. The third type
of tissue test, called a plasma cell labeling index,
assesses how fast myeloma cells are dividing.
A serum viscosity test is done to assess for increased
blood thickness, a condition called hyperviscosity.
In addition, HLA typing is needed if you will have
treatment with an allogeneic stem cell transplant. For
more details and information about each test listed in
the chart, see Part 2 on page 14.
For a solitary plasmacytoma, see
Part 4.2 on page 42 for treatment
recommendations. For multiple
myeloma that is not causing
myeloma—see Part 4.3 on page 44
for treatment recommendations. For
multiple myeloma that is causing
symptoms—called active myeloma—
see Part 4.4 on page 46 for treatment