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Protein Testing in Patients with Multiple Myeloma: A Review of Clinical Effectiveness and Guidelines

Last updated: January 9, 2015
Project Number: RC0618-000
Product Line: Rapid Response
Research Type: Other Diagnostics
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the evidence for the clinical effectiveness and clinical utility of repeat testing for protein abnormalities in patients with MM?
  2. What is the evidence for the clinical effectiveness and clinical utility of testing for protein abnormalities in patients with MM?
  3. What are the evidence-based guidelines regarding the frequency and clinical utility of testing for protein abnormalities in patients with MM?

Key Message

There remains a paucity of information on the clinical effectiveness and clinical utility of repeat testing for protein abnormalities in patients with multiple myeloma. In addition, there is a lack of good quality evidence regarding the clinical utility of the serum free light chain assay and no evidence on the clinical utility of serum protein electrophoresis and urine protein electrophoresis published in the last five years. Studies identified regarding the clinical utility of the serum and urine protein electrophoresis, and the serum free light chain test were heterogeneous in their populations, interventions, treatment regimens, and outcomes. In addition, results may be confounded by the small sample sizes and non-comparative nature of the studies. Therefore, caution should be heeded when interpreting these results. British Society for Haematology guidelines recommend the use of the serum free light chain assay to monitor response to therapy in all patients with oligosecretory disease, non-secretory disease, and light chain only multiple myeloma. In addition, monitoring of patients with asymptomatic multiple myeloma should take place at regular three months intervals to assess for any emergence of myeloma-related organ and tissue impairment using the serum and urine M-protein electrophoresis tests and the serum free light chain assay when indicated.