For patients with clinical suspicion of MM, in addition to the routine admission tests such as blood group and virus, the necessary tests must be completed for MM, and other tests with important value for diagnosis and prognosis are feasible if available. (Table 1 and Table 2)
Table 1 Necessary tests for MM
Test items
Blood tests
Routine blood tests, liver and kidney function (including albumin), electrolytes (including calcium ions), coagulation, serum protein electrophoresis (including M protein percentage), serum immunofixation electrophoresis, serum β2-MG, C-reactive protein (CRP), peripheral blood smear (including peripheral plasma cell percentage), serum immunoglobulin quantification
Urine test
Urine routine, 24-hour urine light chain, urine immunofixation electrophoresis
Bone marrow examination
Bone marrow cytology smear classification
Imaging
Skeletal plain radiographs (including cranial, cervical, thoracic, lumbar, pelvic, femoral, humeral)
Other examinations
Chest CT, electrocardiogram, abdominal ultrasound
Table 2 Items that are valuable for diagnosis or judgment of prognosis
Test items
Specific content
Blood tests
Serum free light chain, troponin, NT-proBNP in patients with cardiac insufficiency and suspected combined cardiac amyloidosis
Urinalysis
24-hour urine protein quantification, urine protein electrophoresis (in MM nephropathy and suspected amyloidosis)
Bone marrow examination
Bone marrow biopsy + immunohistochemistry (recommended immunohistochemistry for bone marrow should include antibodies: CD5, CD19, CD23, CD25, CD20, CD38, CD56, CD138, Kappa, Lambda)
FCM (recommended immunomarkers to include at least: CD45, CD138, CD38, CD56, CD19, Kappa, Lambda, plus CD28, CD27, CD117, CD81, CD200 for conditional units)
FISH [CD138 is recommended for sorting myeloma cells or simultaneous cytoplasmic immunoglobulin staining to differentiate plasma cells, detection sites are recommended to include: IgH rearrangement, 17p- (p53 deletion), 13q14 deletion, 1q21 amplification; if FISH detects positive IgH rearrangement, further detection of t(4;14), t(11;14), t(14;16), t( 14;20), etc.]
Imaging
CT (for suspected bone lesions not suggested by plain films and for those requiring 3D reconstruction)
MRI (for suspected extramedullary lesions, spinal cord and spine injuries, and nerve root compression)
PET-CT (for suspected bone lesions or extramedullary lesions, to assess the proliferation and metabolism of the lesion)
Other examinations
Cardiac ultrasound (in cases of cardiac insufficiency and suspected combined cardiac amyloidosis)
Biopsy of abdominal subcutaneous fat or involved organs or sites, requiring Congo red staining (for suspected amyloidosis)