Diagnosis

Step 1: Get the correct diagnosis

It is important to 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 in your individual situation.

How do I know if I have multiple myeloma?

Symptoms and signs

If you are experiencing the following signs or symptoms, consult with your physician about suspicion of myeloma.

  • Persistent or worsening tiredness due to anemia or reduced kidney function
  • Sudden pain due to a broken bone in the spine, ribs, or elsewhere
  • Recurrent unexplained infections, such as pneumonia, sinus, or urinary infection
  • Pain with movement and/or at night/rest
  • Pain tenderness/swelling of bone areas
  • Swelling, shortness of breath or evidence of heart or kidney failure

Tests

To get the correct diagnosis, you need to undergo a variety of tests. Myeloma may be suspected with the following findings:

  • Anemia
  • Possible low white blood cells or blood platelets
  • Increased blood calcium
  • Increased blood creatinine and/or blood urea nitrogen (BUN)
  • Increased protein level in the blood and/or urine

To learn more about these test, see Step 2: Tests You Really Need.

I’ve undergone lab tests. What do they tell me about my diagnosis?

Once you undergo the proper tests, the presence of myeloma can be assessed using the International Myeloma Working Group diagnostic criteria for multiple myeloma:

The CRAB Diagnostic Criteria

Clonal bone marrow plasma cells ≥10% or biopsy-proven bony or extramedullary plasmacytoma and any one or more of the following myeloma defining events:

Evidence of end organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically:

  • C, or an increase in blood calcium, known as hypercalcaemia: serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2.75 mmol/L (>11 mg/dL)
  • Renal insufficiency: creatinine clearance <40 mL per minute or serum creatinine >177 μmol/L (>2 mg/dL)
  • Anemia: hemoglobin value of >20 g/L below the lower limit of normal, or a hemoglobin value <100 g/L
  • Bone lesions: one or more osteolytic lesions on skeletal radiography, CT, or PET-CT

Any one or more of the following biomarkers of malignancy:

  • Clonal bone marrow plasma cell percentage ≥60%
  • Involved:uninvolved serum free light chain ratio ≥100
  • >1 focal lesions on MRI studies

"Pre-myeloma"

If the above criteria are not met, you may have a precursor (“pre-myeloma”) state that falls into one of three categories:

  • MGUS- monoclonal gammopathy of undetermined significance
  • Smoldering myeloma (low risk)
  • Smoldering myeloma (high risk)

For more information, read the IMF's Understanding MGUS and Smoldering Myeloma booklet. 

I’ve been diagnosed with myeloma. I understand there are different types of myeloma. What does that mean?

Myeloma manifests as different types and subtypes. These types are based on the types of immunoglobulin (protein) produced by the myeloma cell. Normally, the various immunoglobulins have different functions in the body. Each immunoglobulin is made up of two heavy chains and two light chains.

There are five types of heavy protein chains: G, A, D, E and M. There are two types of light protein chains: kappa (κ) and lambda (λ).

IgG myeloma with κ or λ light chains

  • 65% of myeloma patients
  • Has usual features of myeloma

IgA myeloma with κ or λ light chains

  • Next-most common type
  • Sometimes characterized by tumors outside the bone

IgD, IgE, and IgM myeloma

  • Rare types
  • IgD can be accompanied by plasma-cell leukemia and can cause kidney damage.

“Light chain” or “Bence Jones myeloma” 

  • Present in10% of myeloma patients 
  • Most likely to cause kidney damage, and/or lead to deposits of light chains in kidneys and/or on nerves or other organs.

“Non-secretory” myeloma 

  • 1%-2% of myeloma patients