Diagnosing myeloma

A Black woman doctor explaining to a mature white woman

Diagnosis generally begins with tests

Myeloma is sometimes found following a routine blood test. However, more often than not, most people (70%) consult their healthcare professionals because of bone pain that’s not the result of a specific accident or incident. To determine the cause of the pain, an investigative test like an X-ray, CT scan, or MRI is done. Multiple myeloma will be suspected if the test reveals fractures, bone lesions, or breaks.

Because the symptoms of myeloma are often vague and mirror symptoms that can be associated with other health issues, people suspected of having myeloma will usually be referred to a hematologist (blood specialist) for further tests so that a diagnosis can be confirmed.

Testing for myeloma

Diagnostic testingPrognostic testing
ObjectivesTo determine if the person has myeloma, and if so, at which stage.To determine how aggressive the disease is and identify the best course of treatment.
When performedWhen myeloma is suspected.As required to assess the progression of the disease and the effectiveness of treatment.

Below is a small sampling of tests that may be used to diagnose myeloma. Tests typically include those done on the blood, urine, and bone, along with various imaging and/or scans. In some cases, cardiac testing and FISH (Fluorescence in Situ Hybridization) analysis may also be conducted.

MGUS and Smouldering Multiple Myeloma

For a more exhaustive discussion on testing, download Myeloma Canada’s MGUS and Smouldering Multiple Myeloma InfoGuide.

  • Complete blood count (CBC) measures the numbers of different blood cells such as red blood cells (RBCs), white blood cells (WBCs), platelets, and hemoglobin level.
  • Blood chemistry measures total protein and calcium in the blood, as well as kidney function indicator.
  • Other specialized blood tests confirm a myeloma diagnosis and assess disease progression.
  • Urinalysis measures the amount of protein, free light chains (from immunoglobulins), creatinine (a waste product excreted by the kidneys), and bilirubin (a breakdown product of red blood cells) in a urine sample.
  • 24-hour urine test measures the amount of protein in urine over a day.
  • Other specialized urine tests help determine the disease stage and response to treatment.

Tests on your bone (bone marrow aspirate/bone marrow biopsy) may be conducted to determine the health of the bone marrow. Typically, a local anesthetic is applied to numb the area; you may also be given a short-acting sedative to minimize discomfort during the procedure.

For a bone marrow aspirate test, a needle is inserted into your bone, often the back pelvic bone, to extract a sample of liquid marrow. After this, a small core of marrow will be taken from the bone. This is the bone marrow biopsy. The procedure may leave you feeling bruised and you may ache for a few days afterwards, but generally this can be managed with mild painkillers. The bone marrow biopsy is usually an outpatient procedure and takes approximately 15–20 minutes.

For more information on how myeloma affects the bone, read Myeloma Canada’s Myeloma Bone Disease InfoGuide.

Different types of imaging may be necessary, depending on the results of your other tests. These may or may not include some of the following:

  • Skeletal survey: Series of X-rays allowing the limbs, spine, skull, ribs, and pelvis (skeleton) bones to be seen.
  • Whole-body low-dose computerized tomography (WBLDCT); often referred to as a whole-body CT scan: Scan that takes cross-section images of the body using low doses of radiation.
  • Positron emission tomography (PET) scan: Imaging test that requires an injection of a liquid sugar with a radioactive label. Because myeloma cells absorb sugar faster than healthy cells, a specialized camera is able to see where the dye has been absorbed more. PET scans are often combined with computerized tomography (CT) scans.
  • Magnetic resonance imaging (MRI): Uses magnetic fields and radio waves to produce 2-dimensional or 3-dimensional images of organs or structures in the body. MRIs can show where myeloma cells have infiltrated before any bone damage would be visible by X-ray. They can also identify amyloid/light chain deposits in the heart.

When undergoing treatment, some people may need to have monthly or even weekly tests done. At other times, tests may not be required for much longer periods of time.

There is no single schedule for testing. Each person’s situation needs to be assessed and treated individually depending on their condition.

An Asian man looking away smiling

Although myeloma is a blood cancer, it can affect your bones as well.

Myeloma staging and classification

Once active multiple myeloma has been diagnosed, doctors will want to determine the level or stage of the disease.


The main system used to stage active myeloma is the Revised International Staging System (R-ISS). The R-ISS uses 3 blood tests:


beta-2 microglobulin (β2M);




lactate dehydrogenase (LDH).

It also takes into consideration some high-risk chromosomal abnormalities you may have. The abnormalities can be detected by using a test called Fluorescent In Situ Hybridization (FISH) on a sample of purified plasma cells from your bone marrow.

High-risk chromosomal abnormalities are associated with more aggressive or harder to treat myeloma. Such abnormalities include:

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del(17p): a deletion of the short arm of chromosome 17;

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t(4;14): translocation of chromosomes 4 and 14;

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t(14;16): translocation of chromosomes 14 and 16.

Although additional high-risk chromosomal abnormalities have been identified, they’re not used to calculate your R-ISS stage.

Revised International Staging System (R-ISS)

R-ISS Test

Beta-2 microglobulin (β2 M) is less than 3.5 mg/L


Albumin is equal to or greater than 35 g/L


No high-risk chromosomal abnormalities


Normal lactate dehydrogenase (LDH) level

All possible combinations of R-ISS stages 1 and 3

Active myeloma is only staged at the time of diagnosis and the staging is usually not repeated. There are 3 possible stages— Stage 1, Stage 2, and Stage 3—and they are ordered by increasing disease severity.

Multiple Myeloma Patient Handbook

For more information, download the Multiple Myeloma Patient Handbook

Designed to provide educational support to those living with myeloma, their caregivers, families, and friends, this handbook gives accurate, reliable, and clear information on myeloma. Among topics are in-depth discussions on what myeloma is, its causes and effects, treatment options in Canada, and how to manage your myeloma journey.