What is the standard workup for diagnosis of multiple myeloma?

The Bottom Line:  See Tables 1 and 2, p. 4702.

Source: Dimopoulos M, Kyle R, Fermand JP, Rajkumar SV, San Miguel J, Chanan-Khan A, Ludwig H, Joshua D, Mehta J, Gertz M, Avet-Loiseau H, Beksaç M,Anderson KC, Moreau P, Singhal S, Goldschmidt H, Boccadoro M, Kumar S, Giralt S, Munshi NC, Jagannath S; International Myeloma Workshop Consensus Panel 3.  Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3.  Blood. 2011 May 5;117(18):4701-5.

Summary:

Both serum and urine should be assessed for monoclonal protein. Measurement of monoclonal protein both by densitometer tracing and/by nephelometric quantitation is recommended, and immunofixation is required for confirmation. The serum-free light chain assay is recommended in all newly diagnosed patients with plasma cell dyscrasias.  Bone marrow aspiration and/or biopsy along with demonstration of clonality of plasma cells
are necessary. Serum 2-microglobulin, albumin, and lactate dehydrogenase are necessary for prognostic purposes. Standard metaphase cytogenetics and fluorescent in situ hybridization for 17p, t(4; 14), and t(14;16) are recommended. The skeletal survey remains the standard method for imaging screening, but magnetic resonance imaging frequently provides valuable diagnostic and prognostic information.

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