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Baseline testing is required to:
- Determine the exact diagnosis:
- Monoclonal Gammopathy linked to another medical condition
- Monoclonal Gammopathy of Undetermined Significance (MGUS)
- Smoldering myeloma: low risk
- Smoldering myeloma: high risk
- Active myeloma for which systemic anti-myeloma treatment is recommended.
- To form the basis for the selection of the most appropriate anti-myeloma treatment and supportive care as well as provide a comprehensive baseline to adequately monitor response to treatment. Response to treatment is assessed by comparisons with baseline clinical features and laboratory test results.
- Recommended baseline tests:
- The International Myeloma Foundation provides several documents which summarize laboratory testing.
Click to view and/or download the slides for Step 2. ASH 2011 presentations that address STEP 2
REFERENCES
©2011 International Myeloma Foundation
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Blood Tests are done routinely at the time of diagnosis and throughout the disease course to assess response to treatment and side effects, and to monitor for possible relapse.
- Complete blood count (CBC) assesses the presence or absence of anemia, low white cell count, and low platelet count
- Chemistry/Metabolic Panel is particularly important for assessing kidney function (creatinine and BUN), albumin, calcium level, and LDH
- Serum Protein Electrophoresis (SPEP) assesses the amount of abnormal (monoclonal) protein
- Immunofixation demonstrates the type of myeloma protein; i.e., heavy chain (G, A, D, or E); or light chain (kappa or lambda)
- Immunoelectropheresis measures immunoglobulins in the blood or urine. Immunoglobulins are produced by plasma cells, including most myeloma cells.
- Freelite® test (serum free light chain assay) is used to measure the number of free kappa or free lambda light chains (fragments of the monoclonal protein) if it is not possible to quantify heavy chains with serum protein electrophoresis or light chains with urine protein electrophoresis. Some patients' myeloma cells secrete very little or no monoclonal protein that can be detected with SPEP or UPEP; the majority of these patients can be tested adequately with the serum free light chain assay.
Urine Tests
- Urine Protein Electrophoresis (UPEP) shows the amount of monoclonal protein in the urine. Patients must collect urine for 24 hours and it is then sent to the lab for UPEP. Only monoclonal light chains, not heavy chains, are found in urine. Approximately 30% of patients have light chain protein in their urine as well as heavy and light chains in the blood. Approximately 10% of patients have myeloma cells that produce only light chains and no heavy chains.
- Urine Immunofixation identifies the type of abnormal myeloma protein in the urine (kappa or lambda light chains).
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Like many areas in medicine, clinical lab testing often provides few simple answers to commonly asked questions. The issues - on topics like insurance reimbursement and reference ranges - can be very complex. This web site will help you to understand the issues a bit better and help you to ask the appropriate questions of your doctor. |
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Myeloma is a cancer of the plasma cells in the bone marrow. The function of
normal plasma cells is to produce antibodies, also known as immunoglobulins, which
have an important role in fighting infection. Each type of plasma cell produces only one type of immunoglobulin. Normal immunoglobulins are composed of smaller units
called heavy chains and light chains. Each plasma cell also produces only one
type of heavy chain and one type of light chain. When the light chains are attached
to the heavy chains, the light chains are referred to as bound light chains. When the light chains are not attached to the heavy chains, they are called free light chains. In individuals with myeloma and related disorders such as monoclonal gammopathy of undetermined significance (MGUS), excess light chains enter the bloodstream. as free light chains. The amount of free light chain production is linked to the activity of
myeloma or plasma cell growth. |
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