How We Diagnose and Stage Myeloma
While establishing a diagnosis of myeloma, City of Hope doctors also need to determine its stage, meaning how advanced the disease is when first diagnosed. This helps in determining prognosis and in treatment planning.
Initial Tests

Tests and procedures that may be required initially include:
  • Physical exam and history
  • Blood cell counts
  • Blood chemistry tests
  • Urine and blood tests to detect the abnormal myeloma protein
  • Evaluation of a 24-hour urine sample
Bone Marrow Biopsy

To establish a diagnosis of myeloma, a bone marrow aspirate and biopsy are necessary. A biopsy is a test in which a tissue sample is examined under a microscope. A needle is inserted into the hipbone or sternum to obtain a small piece of bone and sample of bone marrow. If there is a solitary plasmacytoma, a biopsy sample may be taken from it for analysis.

If the bone marrow biopsy reveals more than 10 percent plasma cells in the marrow, this condition is known as bone marrow plasmacytosis, and is the determining factor in making a diagnosis of myeloma.


There are two staging systems for multiple myeloma. The Durie-Salmon classification system, which classifies myelomas into stages I, II and III, with stage III being the most advanced stage. Patients with stage I disease may not require immediate treatment, while patients with stage II or III disease have active, symptomatic myeloma. Also, the international staging system which uses B2 microglobulin and serum albumin.

Criteria for staging include:
  • Blood hemoglobin level – later stages have lower blood hemoglobin as a function of anemia
  • Serum calcium level – higher calcium levels, present in later stages, indicate destruction of bone (osteolysis)
  • Presence of bone lesions – the incidence of bone lesions, visible on X-ray and other imaging tests, increases in later stages
  • M protein production rate – increases in later stages of disease
  • Renal function (as measured by serum creatinine clearance) – decreases as the disease progresses

Imaging Tests

Imaging test used in evaluating myeloma:
  • X-ray. A skeletal survey is done which is x-rays of the major bones.