Investigations in elderly patients with myeloma
| Investigation . | Diagnosis . | Prognosis . | Choice of therapy . | Monitoring . | Comments . |
|---|---|---|---|---|---|
| Hemoglobin | + | +/− | − | + | May affect supportive therapy |
| Serum calcium | + | − | − | + | May affect supportive therapy |
| Serum creatinine | + | +/− | + | + | May affect supportive therapy |
| Serum glucose | − | − | +/− | +/− | May affect supportive therapy |
| Serum uric acid | − | − | − | +/− | May affect supportive therapy |
| Bone marrow: plasma cell number, morphology, and plasma cell clonality | + | +/− | − | + | Absence of clonality needed to define stringent CR |
| Bone marrow cytogenetics | − | + | + | +/− | J.M. and S.S. obtain this routinely to determine prognosis for individual patients. M.C. obtains this only in the context of clinical trials or in patients eligible to receive treatment with novel agents. |
| Bone marrow FISH | − | + | + | +/− | J.M. and S.S. obtain this routinely to determine prognosis for individual patients. M.C. obtains this only in the context of clinical trials or in patients eligible to receive treatment with novel agents. |
| LDH | − | + | + | +/− | |
| Skeletal survey | + | − | +/− | +/− | Affects supportive therapy |
| Serum free light chain levels | +/− | − | − | +/− | Essential in patients with nonsecretory or hyposecretory disease; normalization needed to define stringent CR (not validated) |
| Serum albumin | − | + | − | +/− | Essential to apply International Staging System |
| Serum β2-microglobulin | − | + | − | − | Essential to apply International Staging System |
| Serum immunoglobulins | + | − | − | + | |
| Serum protein electrophoresis | + | − | − | + | |
| Serum immunofixation | + | − | − | + | |
| Urine 24-hour protein | + | − | + | + | May affect supportive therapy |
| Urine 24-hour protein electrophoresis | + | − | − | + | |
| Urine 24-hour immunofixation | + | − | − | + | |
| Bone marrow plasma cell labeling index | − | + | − | − | Optional |
| Bone densitometry | − | − | +/− | − | Affects supportive therapy (bisphosphonates may be administered if bone density is low even if there are no osteolytic lesions) |
| Skeletal MRI scan | +/− | − | − | +/− | Optional; may affect supportive therapy (bisphosphonates) and assessment of fracture risk; may show disease activity in patients in serologic CR |
| PET CT | +/− | − | − | +/− | Optional; may show disease activity in patients in serologic CR |
| Echo/MUGA | − | − | +/− | − | Optional; may affect supportive therapy |
| Investigation . | Diagnosis . | Prognosis . | Choice of therapy . | Monitoring . | Comments . |
|---|---|---|---|---|---|
| Hemoglobin | + | +/− | − | + | May affect supportive therapy |
| Serum calcium | + | − | − | + | May affect supportive therapy |
| Serum creatinine | + | +/− | + | + | May affect supportive therapy |
| Serum glucose | − | − | +/− | +/− | May affect supportive therapy |
| Serum uric acid | − | − | − | +/− | May affect supportive therapy |
| Bone marrow: plasma cell number, morphology, and plasma cell clonality | + | +/− | − | + | Absence of clonality needed to define stringent CR |
| Bone marrow cytogenetics | − | + | + | +/− | J.M. and S.S. obtain this routinely to determine prognosis for individual patients. M.C. obtains this only in the context of clinical trials or in patients eligible to receive treatment with novel agents. |
| Bone marrow FISH | − | + | + | +/− | J.M. and S.S. obtain this routinely to determine prognosis for individual patients. M.C. obtains this only in the context of clinical trials or in patients eligible to receive treatment with novel agents. |
| LDH | − | + | + | +/− | |
| Skeletal survey | + | − | +/− | +/− | Affects supportive therapy |
| Serum free light chain levels | +/− | − | − | +/− | Essential in patients with nonsecretory or hyposecretory disease; normalization needed to define stringent CR (not validated) |
| Serum albumin | − | + | − | +/− | Essential to apply International Staging System |
| Serum β2-microglobulin | − | + | − | − | Essential to apply International Staging System |
| Serum immunoglobulins | + | − | − | + | |
| Serum protein electrophoresis | + | − | − | + | |
| Serum immunofixation | + | − | − | + | |
| Urine 24-hour protein | + | − | + | + | May affect supportive therapy |
| Urine 24-hour protein electrophoresis | + | − | − | + | |
| Urine 24-hour immunofixation | + | − | − | + | |
| Bone marrow plasma cell labeling index | − | + | − | − | Optional |
| Bone densitometry | − | − | +/− | − | Affects supportive therapy (bisphosphonates may be administered if bone density is low even if there are no osteolytic lesions) |
| Skeletal MRI scan | +/− | − | − | +/− | Optional; may affect supportive therapy (bisphosphonates) and assessment of fracture risk; may show disease activity in patients in serologic CR |
| PET CT | +/− | − | − | +/− | Optional; may show disease activity in patients in serologic CR |
| Echo/MUGA | − | − | +/− | − | Optional; may affect supportive therapy |
FISH indicates fluorescence in situ hybridization; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; PET, positron emission tomography; CT, computed tomography, +, useful; −, unnecessary; and +/−, usefulness equivocal.