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Bone marrow examination

Examination of the bone marrow is necessary to make the diagnosis of myeloma and to estimate the extent of the disease. A bone marrow biopsy is the procedure to collect a sample of bone marrow.

• Two types of bone marrow samples are taken: Liquid bone marrow (an aspirate) and solid bone marrow within bone core (a biopsy). The biopsy is usually performed on the hip bone.
• The bone marrow is examined under a microscope by a pathologist, a physician who specializes in diagnosing diseases by examining cells and tissues.
• If plasma cells comprise 10-30% of the cells in the bone marrow, this supports the diagnosis of myeloma, in combination with M protein and X-ray findings.
• Bone marrow biopsy may be an uncomfortable, but relatively quick, procedure, so most patients receive some from of premedication to make them more comfortable. It can usually be performed in a medical office.
• Occasionally more involved tests may be performed on the bone marrow. Not all tests listed are routinely performed by the pathologist, but they can be requested by the patient's physician. These may be helpful in assessing prognosis and expected behavior of the myeloma.
• Chromosome analysis: This test identifies chromosome abnormalities in the abnormal plasma cells. Certain chromosome abnormalities are linked to poorer prognosis. Certain chromosomal abnormalities also imply that some specific treatments might be less effective. This test is therefore an important treatment guide.

The following bone marrow tests are under further evaluation and may not be standardly performed:

• Plasmablastic morphology: This test examines the abnormal plasma cells and determines their level of maturity. Fewer mature plasma cells indicate a poorer prognosis.
• Bone marrow microvessel density: A high degree of new blood vessel development in the bone marrow indicates active tumor growth and thus a poorer prognosis.
• Plasma cell labeling index: A high level of this indicator of active plasma cell growth may indicate a poorer prognosis.

Imaging studies

The tests most often used for testing myeloma are x-rays films and magnetic resonance imaging (MRI) scans.

• X-ray films: X-ray films give a general overview of bone damage. A skeletal survey includes x-ray films from every part of the body. Osteolytic lesions look darkened, "punched out," or mottled against the white bone substance on X-ray films. X-ray films can also reveal bone fractures or collapse, as in the vertebrae of the spine.
• MRI: MRI uses differences in magnetic vibrations between different types of tissue to give a detailed picture of body structures. MRI is a good choice to show greater detail of a site where myeloma is suspected of causing damage to nerves, blood vessels, or other soft tissues.

Repeat tests

These tests are used not only to diagnose myeloma but also to monitor the disease's progress over time and to measure response to treatment. Thus, the specialist regularly repeats all or most of these tests to keep track of how the disease is progressing. Tracking the levels of normal and abnormal proteins in the blood is particularly useful in this regard.

In most people, treating the plasma cell tumors stops damage to the bones and kidneys and reverses complications due to low blood cell counts, hypercalcemia, and hyperviscosity. Blood cell counts and hemoglobin, protein, calcium, and other indicators return to normal or near normal levels when the disease is under control.

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