Screening panels for detection of monoclonal gammopathies

Jerry A. Katzmann, Robert A. Kyle, Joanne Benson, Dirk R. Larson, Melissa R. Snyder, John A. Lust, S Vincent Rajkumar, Angela Dispenzieri

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The repertoire of serologic tests for identifying amonoclonal gammopathy includes serum and urine protein electrophoresis (PEL), serum and urine immunofixation electrophoresis (IFE), and quantitative serum free light chain (FLC). Although there are several reports on the relative diagnostic contribution of these assays, none has looked at the tests singly and in combination for the various plasma cell proliferative disorders (PCPDs). METHODS: Patients with a PCPD and all 5 assays performed within 30 days of diagnosis were included (n = 1877). The diagnoses were multiple myeloma (MM) (n = 467), smoldering multiple myeloma (SMM) (n = 191), monoclonal gammopathy of undetermined significance (MGUS) (n = 524), plasmacytoma (n = 29), extramedullary plasmacytoma (n = 10), Waldenström macroglobulinemia (WM) (n = 26), primary amyloidosis (AL) (n = 581), light chain deposition disease (LCDD) (n = 18), and POEMS syndrome (n = 31). RESULTS: Of the 1877 patients, 26 were negative in all assays. Omitting urine from the panel lost an additional 23 patients (15 MGUS, 6 AL, 1 plasmacytoma, 1 LCDD), whereas the omission of FLC lost 30 patients (6 MM, 23 AL, and 1 LCDD). The omission of serum IFE as well as urine lost an additional 58 patients (44 MGUS, 7 POEMS, 5 AL, 1 SMM, and 1 plasmacytoma). CONCLUSIONS: The major impact of using a simplified screening panel of serum PEL plus FLC rather than PEL, IFE, and FLC is an 8% reduction in sensitivity for MGUS, 23% for POEMS (7 patients), 4% for plasmacytoma (1 patient), 1% for AL, and 0.5% for SMM. There is no diminution in sensitivity for detectingMM, macroglobulinemia, and LCDD.

Original languageEnglish (US)
Pages (from-to)1517-1522
Number of pages6
JournalClinical Chemistry
Volume55
Issue number8
DOIs
StatePublished - Aug 1 2009

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Paraproteinemias
Screening
Electrophoresis
Plasmacytoma
Monoclonal Gammopathy of Undetermined Significance
Light
Multiple Myeloma
Amyloidosis
Urine
Waldenstrom Macroglobulinemia
Assays
Plasma Cells
Blood Proteins
Serum
POEMS Syndrome
Plasmas
Serologic Tests

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Katzmann, J. A., Kyle, R. A., Benson, J., Larson, D. R., Snyder, M. R., Lust, J. A., ... Dispenzieri, A. (2009). Screening panels for detection of monoclonal gammopathies. Clinical Chemistry, 55(8), 1517-1522. https://doi.org/10.1373/clinchem.2009.126664

Screening panels for detection of monoclonal gammopathies. / Katzmann, Jerry A.; Kyle, Robert A.; Benson, Joanne; Larson, Dirk R.; Snyder, Melissa R.; Lust, John A.; Rajkumar, S Vincent; Dispenzieri, Angela.

In: Clinical Chemistry, Vol. 55, No. 8, 01.08.2009, p. 1517-1522.

Research output: Contribution to journalArticle

Katzmann, JA, Kyle, RA, Benson, J, Larson, DR, Snyder, MR, Lust, JA, Rajkumar, SV & Dispenzieri, A 2009, 'Screening panels for detection of monoclonal gammopathies', Clinical Chemistry, vol. 55, no. 8, pp. 1517-1522. https://doi.org/10.1373/clinchem.2009.126664
Katzmann JA, Kyle RA, Benson J, Larson DR, Snyder MR, Lust JA et al. Screening panels for detection of monoclonal gammopathies. Clinical Chemistry. 2009 Aug 1;55(8):1517-1522. https://doi.org/10.1373/clinchem.2009.126664
Katzmann, Jerry A. ; Kyle, Robert A. ; Benson, Joanne ; Larson, Dirk R. ; Snyder, Melissa R. ; Lust, John A. ; Rajkumar, S Vincent ; Dispenzieri, Angela. / Screening panels for detection of monoclonal gammopathies. In: Clinical Chemistry. 2009 ; Vol. 55, No. 8. pp. 1517-1522.
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abstract = "BACKGROUND: The repertoire of serologic tests for identifying amonoclonal gammopathy includes serum and urine protein electrophoresis (PEL), serum and urine immunofixation electrophoresis (IFE), and quantitative serum free light chain (FLC). Although there are several reports on the relative diagnostic contribution of these assays, none has looked at the tests singly and in combination for the various plasma cell proliferative disorders (PCPDs). METHODS: Patients with a PCPD and all 5 assays performed within 30 days of diagnosis were included (n = 1877). The diagnoses were multiple myeloma (MM) (n = 467), smoldering multiple myeloma (SMM) (n = 191), monoclonal gammopathy of undetermined significance (MGUS) (n = 524), plasmacytoma (n = 29), extramedullary plasmacytoma (n = 10), Waldenstr{\"o}m macroglobulinemia (WM) (n = 26), primary amyloidosis (AL) (n = 581), light chain deposition disease (LCDD) (n = 18), and POEMS syndrome (n = 31). RESULTS: Of the 1877 patients, 26 were negative in all assays. Omitting urine from the panel lost an additional 23 patients (15 MGUS, 6 AL, 1 plasmacytoma, 1 LCDD), whereas the omission of FLC lost 30 patients (6 MM, 23 AL, and 1 LCDD). The omission of serum IFE as well as urine lost an additional 58 patients (44 MGUS, 7 POEMS, 5 AL, 1 SMM, and 1 plasmacytoma). CONCLUSIONS: The major impact of using a simplified screening panel of serum PEL plus FLC rather than PEL, IFE, and FLC is an 8{\%} reduction in sensitivity for MGUS, 23{\%} for POEMS (7 patients), 4{\%} for plasmacytoma (1 patient), 1{\%} for AL, and 0.5{\%} for SMM. There is no diminution in sensitivity for detectingMM, macroglobulinemia, and LCDD.",
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AU - Lust, John A.

AU - Rajkumar, S Vincent

AU - Dispenzieri, Angela

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