Multiple Myeloma is a hematologic cancer of the plasma cells, which are found in the bone marrow. Early symptoms of Multiple Myeloma include fatigue, back pain and bone pain. Because these symptoms are non-specific, patients often go first to their primary care physician which can delay diagnosis, resulting in a more progressive disease. This year alone, the American Cancer Society predicts 34,920 new cases and 12,410 expected deaths from Multiple Myeloma.
Multiple Myeloma is a disease with many faces. It usually presents in old age but may occur in youth. Bone pain and fractures are characteristic, but soft tissue involvement by plasmacytomas may also occur. Some patients may die within a few weeks of presentation, while others smolder for years. Patients may develop renal failure, acute and chronic infections, or AL amyloidosis, and many will require stem cell transplantation or intensive chemotherapy. It is obvious with such a disease the patient could present to any number of medical specialties.
National and international guidelines for identifying and managing patients with plasma cell dyscrasias are published and updated on a regular basis. The International Myeloma Working Group recommends serum free light chain analysis for screening, prognosis, monitoring, and response management. Although serum free light chain analysis is only a part of the panel required for definitive diagnosis, the availability and fast turnaround time of this analysis is helpful when the clinical question is whether the patient’s problem is resulting from multiple myeloma or a plasma cell dyscrasia. Any abnormality in the serum free light chain results (free kappa light chains, free lambda light chains and kappa/lambda ratio) could point the way to further testing.
Current guidelines show that patients are only getting the correct group of tests once they arrive at a HemOnc physician. By that time, it is often too late. Due to the advances in both laboratory testing and treatment, both the time and cost of diagnosis can be drastically decreased with screening in the primary care setting. Recommendations from the International Myeloma Working group suggests that primary care physicians are the first line of defense in diagnosis.
The current guidelines are:
Monoclonal Protein (Myeloma) Screen Panel
- Serum Protein Electrophoresis with reflex to IFE (performed if restricted band is identified)
- Kappa/Lambda Free Light Chains
Monoclonal Protein (Amyloid) Evaluation Panel
- Immunofixation Electrophoresis (includes SPE)
- Kappa/Lambda Light Chains
- Monoclonal Protein Study, 24 hr urine
Monoclonal Protein (Myeloma) Monitoring Panel
- Immunofixation Electrophoresis (includes SPE)
- Kappa/Lambda Light Chains
- Monoclonal Protein Study, 24 hr urine
Rhys Harris, MD is the Medical Director of Southeast Clinical Labs.