Multiple myeloma

• Full blood count (FBC) – Measures the different types of blood cells in your blood. This is a simple blood test and will be done regularly during treatment.
• Kidney function – Checks how well your kidneys are working and for any signs of damage. In particular, the levels of urea, electrolytes and creatinine will be checked. These blood tests will be done regularly during treatment
• Lactate dehydrogenase (LDH) – This blood test gives information about the growth of myeloma cells and helps with staging your myeloma.
• Calcium levels – A simple blood test to measure the level of calcium in your blood. 
• Normal proteins – The levels of normal proteins, such as albumin, in your blood and urine are also checked. This is because there is less albumin in your blood when multiple myeloma occurs. This test will be done regularly during treatment. 
• Immunoglobulins – This test measures the amounts of antibodies or immunoglobulins found in your blood. These are called IgA, IgD, IgE, IgG and IgM. Myeloma can reduce the number of normal immunoglobulins.
• Tumour markers – substances in your blood that can give information about the cancer.
• Levels of beta-2 microglobulin – this is known as a tumour marker and can help to stage the myeloma.
• Bence Jones paraprotein – found in about 1 in 10 patients with myeloma. You may need to collect urine over a 24-hour period for this test. 

Plasma cells make proteins called immunoglobulins, which is another word for antibodies. With most types of multiple myeloma, the affected plasma cells make abnormal immunoglobulins. These are called paraproteins or M-proteins. Paraproteins come in 2 forms

• A full immunoglobulin 
• A small part of the immunoglobulin (called a light chain). 

In most myeloma cases, both types of paraprotein will be found, but in a minority of cases it will be just one or the other. 

Your blood and possibly urine will be tested to see what type of paraprotein your myeloma cells are making and will also measure the amount of the paraprotein. This will help confirm the diagnosis and also can be used to monitor response to treatments. 

These tests include:

• Blood tests called SPEP and serum-free light chain ratio test. 
• A urine test is called UPEP, which may involve collecting all of your urine for a 24 hour period.

A tiny sample of your bone marrow, which contains plasma cells, is examined under a microscope to see the number of multiple myeloma cells. You may have this test to see how you are responding to treatment. It may also be used to diagnose myeloma.

Aspirate refers to a sample of bone marrow fluid. Biopsy refers to a solid bone marrow sample. Usually the sample is taken from the top part of your hip bone. You can still have this test if you’ve had a hip replacement, as the sample is taken from a different part of the hip

Read more about bone marrow biopsies.

Bone marrow can be checked to see if there are any abnormal chromosomes. This is called cytogenetic testing or FISH (fluorescence in situ hybridisation).

Knowing about any chromosome changes can help your doctors decide which treatments will work best for you and give information about how your disease might progress. 

It can take several weeks to get the results, but it will not affect your immediate treatment start date. However, in some instances your doctor may need to change your treatment when the cytogenetic tests come back, based on the results.

Your doctor will want you to have a CT scan because it is better at showing up bone damage than a plain X-ray. A CT scan is a type of X-ray that takes pictures of your body from different angles. The machine is shaped like a giant doughnut and is linked to a computer. The computer can make a detailed picture of your bones and organs.

Read more about CT scans.

This scan can give your doctor more information about the extent of your multiple myeloma. It is also used if you have bad back pain and to detect spinal cord compression,

Read more about MRI scans.

A PET scan uses a low dose of radioactive sugar that shows up areas of activity on a scan picture. A PET scan is helpful to determine the extent of myeloma bone disease and if there are any myeloma cells present outside the bone marrow (extramedullary myeloma).

Read more about PET scans.

The beta-2 microglobulin is less than 3.5mg/l and the albumin level is greater than or equal to 3.5g/dl.

The levels of beta-2 microglobulin and albumin fall between those in stages 1 and 3.

The beta-2 microglobulin level is greater than or equal to 5.5 mg/l.