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Subspecialties Biochemistry and molecular biology, Clinical care, Laboratory management, Microbiology and immunology, Screening and monitoring, Oncology

An Untrustworthy Myeloma Assay?

Even for blood cancers, the answer to diagnostic puzzles can be hidden elsewhere. Myeloma, a cancer of the plasma cells, is one such example. The serum free light chain assay (SFLCA) has a one-in-four chance of missing the signs of disease; other assays – such as serum protein electrophoresis (SPEP) and serum immunofixation electrophoresis (SIFE) – are more reliable, but equally invasive. Plus, they are less likely to be ordered if clinicians have faith in the newer SFLCA test. The solution? A simple, noninvasive legacy test that examines the urine for signs of disease.

Gurmukh Singh, Vice Chair of Clinical Affairs for the Department of Pathology at the Medical College of Georgia at Augusta University, explains: “During regular examinations of the data generally used in diagnosis and monitoring of multiple myeloma (and other monoclonal gammopathies) from patients being treated at Medical College of Georgia, I noticed disparities in the findings from protein electrophoresis results and SFLCA.” The International Myeloma Working Group recognizes SPEP and SIFE as the gold standards for diagnosing myeloma, so the discrepancies between those tests and the SFLCA results prompted Singh and his colleagues to perform a retrospective analysis of the data (1).

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