From the Guidelines
Multiple myeloma diagnosis and management should prioritize the use of Serum Protein Electrophoresis (SPEP) testing, along with other diagnostic tools like serum-free light chain assay, to detect and monitor abnormal M-proteins, as recommended by the most recent guidelines 1.
Key Diagnostic Tests
- SPEP testing is crucial for detecting abnormal M-proteins in the blood, which is a hallmark of multiple myeloma.
- Serum-free light chain assay is also essential for diagnosing and monitoring multiple myeloma, especially in patients with light chain amyloidosis or oligosecretory myeloma.
- Urine protein electrophoresis and immunofixation electrophoresis are necessary for evaluating urinary M-proteins.
- Bone marrow aspiration and biopsy are recommended to detect quantitative and/or qualitative abnormalities of bone marrow plasma cells.
Overlap with Rheumatology
- There is significant overlap between multiple myeloma and rheumatologic conditions, as both can present with similar symptoms like joint pain, fatigue, and inflammation.
- Some rheumatologic conditions like rheumatoid arthritis can also produce abnormal proteins that may appear on SPEP, though typically in different patterns than myeloma.
- Collaboration between hematologists and rheumatologists is often necessary for proper diagnosis, especially in cases where conditions like MGUS (Monoclonal Gammopathy of Undetermined Significance) may be found incidentally during rheumatologic workups.
Treatment and Monitoring
- Patients with multiple myeloma may experience bone pain, anemia, kidney problems, and increased infection risk, requiring treatments ranging from watchful waiting to chemotherapy, stem cell transplants, and targeted therapies like proteasome inhibitors (bortezomib) or immunomodulatory drugs (lenalidomide).
- Regular SPEP testing is essential for monitoring disease progression and treatment effectiveness in these patients, as recommended by the latest guidelines 1.
- The use of next-generation sequencing (NGS) and minimal residual disease (MRD) assessment can also help identify patients with high-risk disease and monitor treatment response, although these tests are not yet fully reimbursed in several countries 1.
From the FDA Drug Label
Daratumumab may be detected on serum protein electrophoresis (SPE) and immunofixation (IFE) assays used for monitoring disease monoclonal immunoglobulins (M protein) False positive SPE and IFE assay results may occur for patients with IgG kappa myeloma protein impacting initial assessment of complete responses by International Myeloma Working Group (IMWG) criteria
Multiple Myeloma and SPEP Testing: Daratumumab can interfere with serum protein electrophoresis (SPE) and immunofixation (IFE) tests, which are used to monitor monoclonal immunoglobulins (M protein) in patients with multiple myeloma.
- This interference can lead to false positive results, particularly in patients with IgG kappa myeloma protein.
- To address this issue, a daratumumab-specific IFE assay can be used to distinguish between daratumumab and any remaining endogenous M protein in the patient's serum 2. Overlap with Rheumatology: There is no direct information in the provided drug label regarding the overlap of multiple myeloma, SPEP testing, and rheumatology.
From the Research
Multiple Myeloma Overview
- Multiple myeloma is a type of cancer that accounts for 1.6% of all cancer cases and approximately 10% of hematologic malignancies in the United States 3.
- The disease is more common in patients older than 65 years, with 85% of those diagnosed being in this age group, and there is a twofold increased incidence in blacks compared with whites 3.
- Patients may present with bone pain or nonspecific symptoms such as nausea, vomiting, malaise, weakness, recurrent infections, and weight loss 3.
SPEP Testing
- Serum protein electrophoresis (SPEP) is a laboratory test used to detect and quantify monoclonal proteins in the serum, which is a characteristic feature of multiple myeloma 3.
- SPEP testing is an essential component of the diagnostic workup for multiple myeloma, along with other tests such as complete blood count, serum chemistries, and bone marrow evaluation 3.
Overlap with Rheumatology
- Multiple myeloma can present with symptoms that overlap with rheumatologic disorders, such as bone pain and weakness 3.
- Rheumatologists may be involved in the diagnosis and management of patients with multiple myeloma, particularly in cases where the disease presents with musculoskeletal symptoms 3.
- The treatment of multiple myeloma often involves a multidisciplinary approach, including oncologists, hematologists, and rheumatologists, to manage the various aspects of the disease 4, 5, 6, 7.
Treatment Options
- The treatment of multiple myeloma typically involves a combination of chemotherapy, immunomodulatory agents, and stem cell transplantation 4, 5, 6, 7.
- Lenalidomide, bortezomib, and dexamethasone (VRD) is a common induction regimen used in the treatment of newly diagnosed multiple myeloma, followed by autologous stem cell transplantation (ASCT) in eligible patients 6, 7.
- Pomalidomide, bortezomib, and dexamethasone is another regimen that has shown efficacy in patients with relapsed or refractory multiple myeloma who have previously received lenalidomide 5.