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What Blood Tests Will Give Me a Clear Picture of My Myeloma?

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Published on May 4, 2017

What is multiple myeloma? In this Patient Power replay, experts Dr. Larry Anderson and Dr. Robert Orlowski discuss some of the symptoms associated with multiple myeloma and the different ways a diagnosis can be reached. Dr. Larry Anderson is an Associate Professor in UT Southwestern Medical Centerâ??s Department of Internal Medicine. Dr. Orlowski is the Chair, Ad Interim, of the Department of Lymphoma and Myeloma, Director of the Myeloma at MD Anderson Cancer Center.

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Transcript | What Blood Tests Will Give Me a Clear Picture of My Myeloma?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:         

All right. So symptoms. So when somebody comes to you, how has it shown up? Lynette, who we’re going to meet a little while ago, she had a routine blood test and her blood was out of whack. And then as they pursued it, they found out it was myeloma.

Sometimes it’s that, but sometimes there are other symptoms, right?

Dr. Anderson:            

Yes. So the most common or one of the most common symptoms would be fatigue, and that leads to some blood work that may show anemia or low hemoglobin. And then often that would include a chemistry panel that would show elevated protein levels. And that anemia, together with elevated protein, would lead people on to do further testing such as electrophoresis, another test to look for specifically myeloma-related protein.

Andrew Schorr:         

You mentioned plasma earlier. So we have red cells and white cells. We know about platelets. Where does this plasma fit in? 

Dr. Orlowski:             

Plasma cells are a subtype of white blood cells. They’re derived from B lymphocytes, and they’re the most mature form of B lymphocytes that secrete these antibodies or monoclonal antibodies against infections.

Andrew Schorr:         

How do you get a read on not just whether to confirm somebody as myeloma but what their myeloma situation is? What tests are you going to order?

Dr. Orlowski:             

Typically, you would want to do blood tests to look at the blood counts. As Larry mentioned, there are chemistry panels which are done to look at calcium levels, look at protein levels, look at kidney function. Usually there are some radiology studies that are done, looking for bone abnormalities. Most often those are what are called lytic lesions, which are areas where the bone is less dense because as the myeloma grows, it, if you will, hollows out the bone to make more room for itself. And usually a bone marrow aspirate and biopsy is necessary to confirm the diagnosis.

And it also allows us to do some testing, for example, gene expression profiling. And we also do FISH, which is a type of chromosome analysis, and we also can sequence certain genes which help us to determine whether myeloma is a standard risk, or some patients—about 15 t0 20 percent at diagnosis—have what we consider to be high-risk myeloma.

Because although the disease responds, it typically relapses more quickly.

Andrew Schorr:         

So, Dr. Orlowski, though, you mentioned some of the testing. But that’s not done everywhere. Now, you are a leader in the field. What is the recommendation now as to what tests, wherever they are, should get, so there’s a clear picture of their myeloma? 

Dr. Orlowski:             

Definitely great question. An internist or primary care physician can order the blood tests as well as the radiology tests. But they usually are not the ones involved in doing the bone marrow testing, and some of the molecular testing that I mentioned is very specialized. And so it really helps to go to a myeloma specialist, as you’ve said before. You can come to MD Anderson, you can go to Anderson MD or any other myeloma specialist.

But the main tests that you want to do on the bone marrow are there are, of course, the pathology tests which are meant to confirm that myeloma is present. Sometimes we do what’s called flow cytometry, which is kind of like a fingerprint of each of the cells in the liquid from the bone marrow. And then there is the FISH testing, which is looking for certain abnormalities that are very common in myeloma. There’s gene expression profiling, which tells us which genes are on and which genes are off in the myeloma cell.

And then there is sequencing, because there are a certain number of mutations which are common in myeloma, and depending on which mutations are present, that may predict the behavior, the aggressiveness of the myeloma. And more and more, it will be helping us to decide what is the best therapy for that particular type of myeloma.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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