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LetterCorrespondence

Re: Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis

Gurmukh Singh
The Journal of the American Board of Family Medicine March 2017, 30 (2) 265; DOI: https://doi.org/10.3122/jabfm.2017.02.160356
Gurmukh Singh
Department of Pathology Medical College of Georgia at Augusta University, Augusta
MD, PhD, MBA
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To the Editor: The article by Goldshmidt et al1 addresses an important issue of the impact of early diagnosis in the outcome of patients with multiple myeloma. The authors mention that some have advocated use of serum-free light-chain assay (SFLCA) for “screening.” SFLCA has been promoted for diagnosing, determining the prognosis, and monitoring of monoclonal gammopathies.2 However, empirical evidence suggests a far more limited role for SFLCA. Serum protein electrophoresis and serum immunofixation electrophoresis are the gold standards for diagnosis;3 these two alone are sufficient to diagnose about 95% cases. Patients with light-chain gammopathy can be detected by urine protein electrophoresis and urine immunofixation electrophoresis.

Among patients without monoclonal gammopathy, the κ-to-λ ratio is abnormal in >35%, and the false-positive rate is about 55% in patients with polyclonal hypergammaglobulinemia.4 In monoclonal gammopathy there is an overall 27% false-negative κ-to-λ ratio. The false-negative rate is up to 67% for patients with monoclonal gammopathy of undetermined significance.5 SFLCA and κ-to-λ ratio have virtually no role in the diagnosis of monoclonal gammopathy, as an abnormal κ-to-λ ratio is not diagnostic of monoclonal gammopathy and a normal κ-to-λ ratio does not exclude monoclonal gammopathy.6

Notes

  • To see this article online, please go to: http://jabfm.org/content/30/2/265.full.

  • The above letter was referred to the author of the article in question, who offers the following reply.

References

  1. 1.↵
    1. Goldschmidt N,
    2. Zamir L,
    3. Poperno A,
    4. Kahan NR,
    5. Paltiel O
    . Presenting signs of multiple myeloma and the effect of diagnostic delay on the prognosis. J Am Board Fam Med 2016;29:702–9.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Bradwell A
    . Serum free light chain analysis plus Hevylite. 7th ed. Birmingham, UK: Binding Site Group Ltd; 2015.
  3. 3.↵
    1. Rajkumar SV,
    2. Dimopoulos MA,
    3. Palumbo A,
    4. et al
    . International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15:e538–48.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Singh G
    . Serum free light chain assay and κ/λ ratio performance in patients without monoclonal gammopathies: high false-positive rate. Am J Clin Pathol 2016;146:207–14.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Kyle RA,
    2. Buadi F,
    3. Rajkumar SV
    . Management of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). Oncology (Williston Park) 2011;25:578–86.
    OpenUrlPubMed
  6. 6.↵
    1. Singh G
    . Serum free light chain assay and κ/λ ratio: performance in patients with monoclonal gammopathy-high false negative rate for κ/λ ratio. J Clin Med Res 2017;9:46–57.
    OpenUrl
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The Journal of the American Board of Family     Medicine: 30 (2)
The Journal of the American Board of Family Medicine
Vol. 30, Issue 2
March-April 2017
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Re: Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis
Gurmukh Singh
The Journal of the American Board of Family Medicine Mar 2017, 30 (2) 265; DOI: 10.3122/jabfm.2017.02.160356

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Re: Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis
Gurmukh Singh
The Journal of the American Board of Family Medicine Mar 2017, 30 (2) 265; DOI: 10.3122/jabfm.2017.02.160356
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