What Tests Are Needed to Diagnose Multiple Myeloma in Older Adults?
Multiple myeloma is a type of blood cancer that primarily affects plasma cells in the bone marrow, and it is most commonly diagnosed in older adults. Early and accurate detection is crucial for effective treatment planning and improved outcomes. A comprehensive diagnostic approach involves a combination of laboratory tests, imaging studies, and tissue analysis to confirm the presence of malignant plasma cells and assess the extent of organ involvement.
Blood Tests: Evaluating Blood Cell Health and Protein Levels
Blood tests are among the first steps in evaluating suspected multiple myeloma. A complete blood count (CBC) helps determine red blood cell morphology and quantity, detect anemia, and evaluate platelet count and function. Abnormal results may indicate bone marrow suppression due to cancer infiltration.
In addition, serum protein electrophoresis and immunofixation are used to examine the balance between albumin and globulin proteins. In many patients with multiple myeloma, there is a reversed albumin-to-globulin ratio caused by excessive production of abnormal immunoglobulins—also known as M proteins—by malignant plasma cells. This overproduction often leads to hyperviscosity syndrome and impaired immune function.
Urine Analysis: Monitoring Kidney Function and Detecting Bence Jones Proteins
Urinalysis plays a vital role in assessing kidney damage, which is common in multiple myeloma due to the accumulation of light chains (known as Bence Jones proteins) in the renal tubules. A routine urinalysis can reveal proteinuria, hematuria, or signs of impaired filtration.
More specifically, urine protein electrophoresis and quantitative measurement of free light chains help identify monoclonal light chains excreted in the urine. These findings not only support the diagnosis but also assist in monitoring disease progression and response to therapy.
Importance of Renal Assessment in Elderly Patients
Older adults are particularly vulnerable to kidney complications due to age-related decline in renal function. Therefore, early detection of myeloma-related nephropathy through urine testing is essential to prevent irreversible damage and initiate protective measures such as hydration and avoidance of nephrotoxic drugs.
Bone Marrow Examination: Confirming the Diagnosis
A bone marrow aspiration and biopsy are definitive procedures for diagnosing multiple myeloma. These tests allow hematologists to examine the percentage, shape, and distribution of plasma cells within the marrow.
A plasma cell count exceeding 10%—especially if clonal—is highly suggestive of myeloma. Cytogenetic studies and fluorescence in situ hybridization (FISH) may also be performed on the sample to identify high-risk genetic abnormalities such as deletions in chromosome 17 or translocations involving immunoglobulin genes.
Imaging Studies: Detecting Bone Lesions and Extramedullary Disease
Radiographic evaluation is critical because multiple myeloma often causes lytic bone lesions, osteoporosis, and pathological fractures, especially in weight-bearing areas like the spine and pelvis.
X-Ray: Initial Screening for Skeletal Damage
Conventional skeletal surveys using X-rays are typically used to detect bone destruction in the vertebrae, ribs, skull, and long bones. While useful, X-rays may miss early or small lesions, making them less sensitive in early-stage disease.
CT Scans: Enhanced Visualization of Bone and Soft Tissue Involvement
Computed tomography (CT) offers greater detail than standard X-rays and is particularly valuable in identifying subtle bone lesions and extramedullary tumor spread—areas where myeloma cells grow outside the bone marrow. CT scans are more likely to detect lesions that appear normal on X-ray, especially during the initial phases of the disease.
MRI: Superior Detection of Spinal and Marrow Infiltration
Magnetic resonance imaging (MRI) is considered the gold standard for evaluating spinal involvement and detecting early marrow infiltration. It excels at revealing bone marrow edema, nerve compression, and soft tissue masses before structural collapse occurs.
Early MRI detection of spinal changes can prevent serious complications such as paralysis, allowing timely intervention with radiation therapy, surgery, or systemic treatment.
Inflammatory Markers and Disease Activity Monitoring
Erythrocyte sedimentation rate (ESR), commonly known as sed rate, is frequently elevated in multiple myeloma patients—sometimes reaching over 100 mm/h. This acceleration is linked to increased levels of abnormal immunoglobulins, which reduce repulsion between red blood cells, causing them to stack faster.
An elevated ESR correlates with disease burden and severity, making it a useful marker for tracking treatment response and relapse risk, although it is non-specific and should be interpreted alongside other clinical data.
Comprehensive Evaluation Leads to Better Outcomes
Diagnosing multiple myeloma in older adults requires a multifaceted strategy combining blood and urine tests, bone marrow analysis, and advanced imaging techniques. Each test provides unique insights into disease presence, stage, and potential complications.
With early and precise diagnosis, clinicians can tailor individualized treatment plans—including chemotherapy, targeted therapies, stem cell transplantation, or supportive care—to improve quality of life and extend survival. Regular monitoring using these same tools ensures ongoing management of this complex condition.