Early Screening
Risk factors
· Patient History
Possible associated
for Monoclonal
· Family History
symptoms include*
· Age > 65
PLUS
· Bone Pain
*or the patient may be asymptomatic and
Gammopathies
· More common in men
· Unexplained Anemia
discovered to have a monoclonal gammopathy
(2:1 M/F ratio)
· Fatigue
when abnormal test results are noted
· Linked to obesity
· Recurrent Infections
at the time of a routine checkup
· Cancer-causing
chemicals and radiation
Laboratory work up
· Total Serum Protein Measurement
· Total Urine Protein Measurement
· CBC
Further laboratory work up
If there is bone pain further
Additional laboratory testing
· Chem Panel 1
evaluation is recommended
· SIFE (Serum Immunofixation)
· SPEP + UPEP (Serum Protein Electrophoresis
Normal results ­
· UIFE (Urine Immunofixation)
+ Urine Protein Electrophoresis)
no clinical signs
· Imaging
If light chain disease,
· QIG (Quantitative Immunoglobulin)
· 2M (Beta 2 Microglobulin)
· Bone Density
the variants considered
· Serum Free Light Chain (optional)
· Possible Bone Marrow test
· Light Chain Myeloma3
· Hypo or Non Secretory
Report to Physician
Myeloma
· Systemic Amyloidosis
(Congo Red positive)2
At least one abnormal result
· Systemic Light Chain
· Evidence of Monoclonal
Deposition Diseases
Gammopathy
Complementary tests
· Total Protein Elevated
Report to Physician
At least one abnormal result
and/or unexplained Anemia
No abnormalities
Patient monitoring
SIFE + UIFE if not yet performed
Refer to Monitoring Patients
Abnormal results
+ Test for SCRC2 and/or SLCD3
Normal results
with M-Proteins flowchart
+ Serum Free Light Chain
1 Chemical panel = Glucose, Sodium, Potassium, Chloride, Carbon Dioxide, BUN, Creatinine, Calcium, Albumin from SPEP, and liver function tests
2 Congo Red stain of biopsy material
3 SLCD (Systemic Light Chain Deposit )
© 2010 International Myeloma Foundation
References are available, see the IMWG Guidelines at www.myeloma.org.

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