Diagnosis
It is important to recognize the early warning signs and diagnose myeloma as early as possible. Myeloma can be slow-moving or more aggressive.
A skilled myeloma specialist is able to determine the best approach for an individual based on his or her unique situation. The International Myeloma Working Group (IMWG) provides the most effective and up-to-date information regarding diagnosis of the multiple myeloma patient, whether monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or active myeloma. The information is summarized here:
Initial Workup
Initial testing will help to determine the stage of the disease, which will vary between patients at diagnosis. Read more about Staging and Risk Stratification in myeloma.
The initial workup will include blood, bone marrow, imaging, and genetic testing. Genetic testing should be performed on a patient's bone marrow biopsy specimen at the time of diagnosis to help predict the behavior of the myeloma and its response to various treatment strategies. Tests which are performed include Conventional Metaphase Cytogenetics (karyotyping) and FISH (Fluorescent In Situ Hybridization) testing.
Visit NLB Resource--Essential Tests for more information about essential tests throughout the disease continuum.
Survivorship Care Begins at Diagnosis
Managing symptoms of both the disease and side-effects of treatment is increasingly important with extended survival in MM. Symptom management should begin at diagnosis and continue throughout treatment and maintenance. Patients most commonly require supportive care for bone disease, kidney disease, peripheral neuropathy, infections, thromboembolic events (VTEs), and GI side effects.
- The importance of Symptom Care from a nursing perspective
- Survivorship Care Guidelines Consensus Statement
- Survivorship Care Plan Key Components
- Immunizations (NO live vaccines)
- Pneumococcal vaccination (13 and 23)
- Seasonal inactivated influenza
- Shingles vaccine: Zoster vaccine recombinant, adjuvanted
Visit NLB--Managing Complications and Side Effects for detailed information about managing complications and side effects.
Additional Resources
Advanced practitioners who do not treat many myeloma patients may find the following educational resources helpful:
| Apps | Focus |
| CDC Vaccine Schedules App (Centers for Disease Control and Prevention) | CDC-recommended immunization schedules and footnotes |
| National Comprehensive Cancer Network | NCCN guidelines for supportive care and treatment of cancer |
| Calculate App (QxMD Medical Software, Inc) | • Clinical calculators and decision support tools • Staging and prognosis tools for myeloma |
| Adapted from Brigle et al. J Adv Pract Oncol 2016 Mar; 7 Suppl 1: 79-82. | |
Patient Resources
Patients and their caregivers will likely be seeking both immediate educational resources, as well as ongoing support. The advanced practitioner may wish to direct them to reputable sources, such as the following websites:
| Organization | Website |
| International Myeloma Foundation | myeloma.org |
| Leukemia & Lymphoma Society | lls.org |
| The Myeloma Beacon | myelomabeacon.com |
| Blood & Marrow Transplant Information Network | bmtinfonet.org |
Pill reminder apps can be a useful tool for patients. There are many to choose from.
Additional resources can be found here: Patient Resources
The International Myeloma Foundation medical and editorial content team
Comprised of oncology-certified nurses, the Nurse Leadership Board has extensive knowledge of the multiple myeloma treatment and care landscape. These resources were developed by their team.
Last Medical Content Review: October 25, 2021