Multiple Myeloma: A Structured and Multidisciplinary Approach to Diagnosis

Multiple myeloma is a hematologic malignancy characterized by the clonal proliferation of post-germinal center B cells, leading to monoclonal immunoglobulin (M protein) production. Its diagnosis remains complex due to diverse clinical presentations, ranging from asymptomatic cases detected through routine screening to symptomatic disease with bone pain, renal dysfunction, anemia, and hypercalcemia. A multimodal diagnostic approach integrating imaging, laboratory testing and bone marrow evaluation is essential for accurate disease characterization. Advances in serum protein electrophoresis (SPEP), immunofixation (IFE), free light chain (FLC) assays, next-generation sequencing (NGS), and artificial intelligence (AI)-assisted imaging have refined diagnostic precision, enabling earlier detection and better risk stratification. This review provides an overview of current and evolving diagnostic strategies in multiple myeloma, highlighting their impact on disease detection and classification.