Protein manifestations characteristic of multiple myeloma (MM) include increases of monoclonal (M)-protein concentrations (IgG, IgA, IgA, IgD), light chain concentrations (including kappa [κ] and lambda[λ]), abnormal β₂-microglobulin, serum albumin, creatinine, and hemoglobin levels, and findings of bone marrow plasma cells (of greater than or equal to 5%). Measurement of the protein manifestations produced by patients can be achieved by numerous methods. Traditional tests that measure M-proteins are the 24-hour urine collection test, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunofixation electrophoresis (IFE). One newer test (developed in 2001) is the serum free light chain (sFLC) assay. The frequency with which to test using any of the tests along with the clinical utility of the newer tests remains in question. It is for this reason that a review of the clinical effectiveness, clinical utility, and guidelines of repeat testing for protein abnormalities in patients with MM was undertaken.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Methods
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Additional References of Potential Interest
• APPENDIX 3 Characteristics of Included Publications
• APPENDIX 4 Critical Appraisal of Included Publications
• APPENDIX 5 Levels of Evidence and Grading Schemes
• APPENDIX 6 Main Study Findings, Author’s Conclusions and Recommendations

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.