Multiple myeloma (MM) is a highly lethal, malignant proliferation from a single clone of plasma cells in the bone marrow that characteristically secrete a monoclonal protein (M protein).
In the vast majority of MM cases a monoclonal protein – often with excess monoclonal free light chains (FLC) – is produced and the detection of this M Protein by serum protein electrophoresis (SPEP) is a key indicator for the diagnosis of MM.
The initial diagnostic workup of a patient suspected of having MM aims to establish the diagnosis, the stage of disease, and prognostic markers which guide treatment choices. The results of pathology tests will help determine the suitability of the patient for autologous stem cell transplant (AuSCT) or chemotherapy with conventional or novel agents.
Biochemistry testing plays a key role throughout all stages of the patient’s journey. From the initial ‘MM screen’ ordered by a GP, on to the diagnostic workup tests of serum and urine immunofixation, ß2microglobulin, serum FLC, calcium, albumin and other tests required for staging and prognosis stratification. Monitoring M protein and FLC continues throughout treatment and then long-term to detect relapse and is an essential part of MM management.
Despite the much improved survival outcome since the introduction of AuSTC and novel therapeutic agents MM is still an incurable disease. However, the availability of high quality biochemistry testing with short turnaround times helps to provide information for the clinician to manage MM with the goal to maximise quality of life and prolong survival.