Effective Test Utilization Recommendations

Use serum free light chain testing with serum protein electrophoresis for evaluating multiple myeloma

Immunology
Multiple myeloma is often diagnosed late, and improper diagnostic work ups can contribute to this delay. Most myeloma patients present in primary care, where providers may be less confident knowing what diagnostic testing to order.1 Combining serum free light chain (sFLC) testing with serum protein electrophoresis and immunofixation, as recommended by guidelines,2,3 enhances diagnostic sensitivity for multiple myeloma. Without sFLC testing, 1 in 8 myeloma cases may be missed.4

REFERENCES

  1. Mikhael J, Bhutani M, Cole CE. Multiple Myeloma for the Primary Care Provider: A Practical Review to Promote Earlier Diagnosis Among Diverse Populations. Am J Med. 2023 Jan;136(1):33-41. doi: 10.1016/j.amjmed.2022.08.030. Epub 2022 Sep 20. PMID: 36150517.
  2. Kumar SK, Callander NS, Adekola K, et al. Multiple Myeloma, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023 Dec;21(12):1281-1301.
  3. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BG, Miguel JF. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014 Nov;15(12):e538-48. doi: 10.1016/S1470-2045(14)70442-5. Epub 2014 Oct 26. PMID: 25439696.
  4. Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA, Rajkumar SV, Dispenzieri A. Screening panels for detection of monoclonal gammopathies. Clin Chem. 2009 Aug;55(8):1517-22. doi: 10.1373/clinchem.2009.126664. Epub 2009 Jun 11. PMID: 19520758; PMCID: PMC3773468.
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