Rising Biomarkers in the Diagnosis of Multiple Myeloma: A Narrative Review

Abstract

Introduction: Multiple Myeloma, a rare and historically deemed untreatable blood cancer, continues to pose a significant health challenge. While the standard of care for multiple myeloma involves managing symptoms long term, there is a growing interest in new modalities of diagnosing and characterizing the disease. Biomarkers, measurable substances in a patient, play a dual role, not only in monitoring the disease but also in the diagnostic process, offering valuable insight into the nature of the cancer. 

Methods: This narrative review evaluated studies published to large academic databases through the utilization of filtering Medical Subjects Headings (MESH) terms pertaining to the topic of multiple myeloma biomarkers. Specific biomarkers and their significance to the development of an understanding of multiple myeloma will be identified and categorized by feasibility of use, taking into account current data and available detection techniques. 

Results: Both traditionally utilized and novel biomarkers for multiple myeloma were included in this study. Literature pertaining to six biomarkers of interest was reviewed: M Protein, immunoglobulin free light chain (FLC), Lactate Dehydrogenase (LDH), circulating tumor DNA (ctDNA), cell-free DNA (cfDNA), and the utilization of bone lesion imaging. M-Protein still remains the gold standard for diagnosing multiple myeloma, but other liquid biopsy measurements (FLC, LDH, ctDNA, cfDNA) and imaging evaluations have become crucial in diagnosing, treating, and understanding the heterogeneity of the disease.

Discussion: These biomarkers have shown to improve the diagnostic and prognostic process of cancer treatment by identifying and measuring patient attributes. As ongoing research endeavors continue to unveil the mechanisms and prevalence of various biomarkers in multiple myeloma, there is an opportunity for refinement and standardization of international guidelines for managing MM patients. Biomarker implementation into the standards of care gives rise to the opportunity of reducing variability between studies and optimizing personalized patient care. 

Conclusion: Biomarkers in multiple myeloma is a rapidly advancing field of translational science which is influencing daily clinical decision making. Further studies need to be done to limit variability in biomarker standards as well as to broaden our understanding of the correlations between biomarkers and disease progression.