Abstract
In this issue of Clinical Chemistry , Piehler et al. (1) present data on the use of serum protein electrophoresis (SPE),1 clinical history, and selective use of serum immunoglobulin free light chain (FLC) assay as a diagnostic screening algorithm for multiple myeloma (MM) in a general hospital population and conclude that this algorithm allows for efficient diagnosis or exclusion of multiple myeloma. The authors investigated clinical histories and sera of the 3818 samples sent to their laboratory for SPE over a 1-year period. These samples translated into 2854 unique patients: 2302 who did not have either an abnormality detected on SPE or a clinical history that included unexplained anemia, renal disease, hypercalcemia, increased sedimentation rate, and/or osteolysis, bone pain, or fractures; and 545 who met at least 1 of these criteria. Of the 545, 157 were excluded because their monoclonal protein had been previously recognized, leaving 332 patients: 83 who had a newly identified monoclonal band on SPE and 249 who had no monoclonal band detected. These 332 patients were subsequently screened with the FLC assay. Of the group without a monoclonal protein detected by SPE, 56 patients had an abnormal FLC ratio, and only 14% of these had a plasma cell disorder. Using this methodology, the authors “missed” only 4 diagnoses—2 myelomas and 2 plasmacytomas—and conclude that their algorithm detected 95% of all cases of MM, Waldenstrom macroglobulinemia, or primary amyloidosis. The authors should be congratulated on this endeavor, but there are 2 major limitations of their study that must be addressed. The first is that clinical …
Highlights
The authors should be congratulated on this endeavor, but there are 2 major limitations of their study that must be addressed
For other, low-tumorburden plasma cell disorders like immunoglobulin light chain amyloidosis (AL), POEMS syndrome, cryoglobulinemia, and immunoglobulin light chain deposition disease, the symptoms are more protean, and recognition of a small monoclonal protein is essential to send the clinician down the right diagnostic path
In 2001, sensitive quantitative assays for serum and free light chains became commercially available (2 ), and it has been repeatedly demonstrated that the ratio of to FLC in serum is very sensitive to clonal expansion of plasma cells that secrete excess FLC (3–5 )
Summary
The authors should be congratulated on this endeavor, but there are 2 major limitations of their study that must be addressed. 1 Nonstandard abbreviations: SPE, serum protein electrophoresis; FLC, free light chain; MM, multiple myeloma; IFE, immunofixation electrophoresis. IFE has been recommended for screening owing to its increased sensitivity for these rarer conditions, and for picking up the 15%–20% of patients with either oligosecretory or light chain myeloma— i.e., those patients whose malignant plasma cells secrete immunoglobulin light chain without associated heavy chain.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.