TriangleHEALTH PROFESSIONAL · SOURCE READING
Initial Evaluation
Source: Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 25, 2025 · Captured 2026-09-09.
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Context: Treatment of Multiple Myeloma
The initial approach to the patient is to evaluate the following parameters:
Detection and quantification of a monoclonal (or myeloma) protein (M protein) in the serum or urine, and possible immunoparesis (suppression of the other uninvolved immunoglobulins [Ig]).[1]
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Detection of more than 10% of plasma cells on a bone marrow examination, along with flow cytometry, cytogenetics, and fluorescence in situ hybridization testing.
Detection of lytic bone lesions or generalized osteoporosis in skeletal x-rays, or whole-body or spinal and pelvic magnetic resonance imaging (MRI) scans, or focal bone lesions on positron emission tomography-computed tomography (CT) scan.[2,3]
Presence of soft tissue plasmacytomas.
Serum albumin and beta-2-microglobulin levels.
Detection of free kappa and free lambda serum Ig light chain, with calculation of the serum free light chain ratio.[1,4]
Presence of hypercalcemia.
Detection of renal dysfunction attributable to the plasma cell dyscrasia (induced by gammopathy or amyloidosis).
Presence of anemia.
Presence of circulating plasma cells.
Presence of hyperviscosity. Asymptomatic patients usually respond to myeloma therapy; plasma exchange is indicated with hemorrhagic or central nervous system manifestations.[5]
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Treatment selection is influenced by the age and general health of the patient, previous therapy, and the presence of disease complications.[6]
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