Abstract
Multiple myeloma (MM) is one of the hematologic malignancies with a greater delay in diagnosis. Laboratories receive numerous MM screening test requests without a specific suspicion, which entails a substantial workload and reduces the efficiency of laboratories. Objective: to increase the efficacy of MM screening protocols. The results of serum protein electrophoresis (SPEP), serum protein immunofixation electrophoresis (SIFE), urine protein immunofixation electrophoresis, and serum free light chain assays of 75 patients with MM, three with amyloidosis, and a patient with solitary plasmocytoma were collected. The frequency of a set of biochemical alterations in these patients was compared with that in controls (n=120). A validation of the screening algorithm was carried out in 261 consecutive patients with a clinical or analytical suspicion of MM. SPEP+SFLC or SIFE+SFLC (98% sensitivity) were the screening algorithms with the highest sensitivity. Prospectively, the SPEP+SFLC detected 27 of the 28 confirmed cases of MG and saved 15h of work. Alterations in five of the six parameters studied were more frequent in the study group, with a cumulative value of≥3 parameters altered (61.1 vs. 1.7%) (positive predictive value: 85%; negative predictive value: 94%). The SPEP+SFLC screening protocol demonstrated the highest sensitivity and was the least time-consuming protocol. In addition, this protocol improves diagnostic sensitivity and laboratory performance.
Highlights
Multiple myeloma (MM) is a clonal disorder of plasma cells characterized by bone marrow plasmacytosis and, in most cases, the production of an abnormal monoclonal immunoglobulin that is detectable by protein electrophoresis in serum and/or urine
The release of neoplastic plasma cells and monoclonal immunoglobulin induces organ and tissue damage resulting in the development of the symptoms typically associated with MM, including bone lesions; anemia, hypercalcemia, and kidney damage
The clinical and laboratory data of 79 patients with a confirmed diagnosis of multiple myeloma (MM), amyloidosis (AL), or solitary plasmacytoma (SP) and of 120 subjects without a monoclonal gammopathy (MG) diagnosis were reviewed to draw a profile of patients with suspicion of MG
Summary
Multiple myeloma (MM) is a clonal disorder of plasma cells characterized by bone marrow plasmacytosis and, in most cases, the production of an abnormal monoclonal immunoglobulin that is detectable by protein electrophoresis in serum and/or urine. The sensitivity of this test is limited, especially if the monoclonal component is small or only contains light chains [4] For this reason, on suspicion of a monoclonal gammopathy (MG), the International Myeloma Working Group (IMWG) recommends the use of a battery of serum screening tests for the detection of monoclonal proteins (MP), which includes SPE, serum immunoglobulin-free light chain (FLC) testing, and serum immunofixation electrophoresis (IFE) [1]. On suspicion of a monoclonal gammopathy (MG), the International Myeloma Working Group (IMWG) recommends the use of a battery of serum screening tests for the detection of monoclonal proteins (MP), which includes SPE, serum immunoglobulin-free light chain (FLC) testing, and serum immunofixation electrophoresis (IFE) [1] This screening algorithm has a high diagnostic sensitivity and specificity, and only requires a sample of serum, which spares the patient and the laboratory the inconveniences of collecting and processing a 24-h urine sample. The use of a single screening test can yield false negative results and delay diagnosis, This work is licensed under the Creative Commons Attribution
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