Testing at relapse for patients not participating in a clinical trial
| Serum |
| Electrophoresis (SPEP) and immunofixation (SIFE) |
| Quantitative Ig |
| Free light chains (FLC) |
| Complete blood count with differential |
| Renal function, calcium |
| Lactate dehydrogenase |
| Albumin and β-2 microglobulin |
| Urine |
| 24-h collection for total protein, electrophoresis, and immunofixation (may not be necessary if patient meets criteria for progressive disease by serum studies3 ) |
| Bone marrow aspiration and biopsy* |
| Histology |
| Flow cytometry |
| Karyotype |
| FISH on CD138-selected plasma cells |
| Imaging |
| X-ray (skeletal survey or imaging of targeted areas) |
| Positron emission tomography–computed tomography |
| Magnetic resonance imaging of spine and pelvis or whole body (as clinically indicated) |
| Serum |
| Electrophoresis (SPEP) and immunofixation (SIFE) |
| Quantitative Ig |
| Free light chains (FLC) |
| Complete blood count with differential |
| Renal function, calcium |
| Lactate dehydrogenase |
| Albumin and β-2 microglobulin |
| Urine |
| 24-h collection for total protein, electrophoresis, and immunofixation (may not be necessary if patient meets criteria for progressive disease by serum studies3 ) |
| Bone marrow aspiration and biopsy* |
| Histology |
| Flow cytometry |
| Karyotype |
| FISH on CD138-selected plasma cells |
| Imaging |
| X-ray (skeletal survey or imaging of targeted areas) |
| Positron emission tomography–computed tomography |
| Magnetic resonance imaging of spine and pelvis or whole body (as clinically indicated) |
FLC, serum free light chains; Ig, immunoglobulin; SIFE, serum immunofixation; SPEP, serum protein electrophoresis.
May not be necessary if serum and/or urine studies demonstrate relapse and clinical picture is consistent with myeloma. Must be done if patient is oligo- or nonsecretory.