What are the European Society for Medical Oncology (ESMO) guidelines for the diagnosis evaluation of multiple myeloma (MM)?

Updated: Jul 15, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The ESMO guidelines recommend basing the diagnosis of multiple myeloma on the following [125]

  • Detection and evaluation of the monoclonal (M) component by electrophoresis of serum and/or urine protein (concentrate of 24h urine collection); nephelometric quantification of IgG, IgA, and IgM immunoglobulins; characterization of the heavy and light chains by immunofixation; and serum FLC measurement

  • Bone marrow aspiration and/or biopsy to evaluate the number and characteristics of plasma cells infiltrating the bone marrow; the bone marrow sample should also be used for cytogenetic/FISH studies on immunologically recognized or sorted plasma cells and also has the potential for immunophenotypic and molecular investigations

  • Evaluation of lytic bone lesions with whole-body low-dose computed tomography (WBLD-CT), or with conventional radiography if WBLD-CT is not available. Magnetic resonance imaging (MRI) provides greater details and is recommended whenever spinal cord compression is suspected. Either whole-body MRI or MRI of the spine and the pelvis may be used, according to their availability, to assess the BM plasma cell infiltration, in particular the presence of bone focal lesions. 18F-fluorodeoxyglucose positron emission tomography with CT (PET-CT) can be done to evaluate bone lesions, according to availability and resources.

  • CBC with differential serum creatinine, creatinine clearance and calcium level


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