Multiple Myeloma

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Pathology

Multiple myeloma (MM) is the second most commonly diagnosed blood cancer after non-Hodgkin lymphoma. Worldwide, it is estimated that 103,000 people were diagnosed with MM in 2008, which represents 12% of all blood cancers diagnosed, according to Cancer Research UK.

MM is a cancer in which plasma cells proliferate uncontrollably and accumulate in the bone marrow. This causes an overproduction of immunoglobulins (antibody proteins) that ultimately crowd out the normal blood-forming cells and prevent them from functioning effectively. The symptoms of MM include bone lesions, anemia and kidney failure. Patients commonly experience bone pain and fractures, with many also experiencing weight loss, fatigue and repeated infections. The exact cause of MM is unknown and a common age for diagnosis is around 70 years old. The disease progression is more akin to a chronic condition.

Since the tumoral plasma cell clone in the bone marrow is increased, the resultant monoclonal protein (or M-protein) is produced at high levels. The M-protein is one of the oldest and best tumor markers of the disease. The only technique that can identify the monoclonality and target the M-protein in body fluids is electrophoresis. With the exception of electrophoresis, there is no other non-invasive test that can be used to perform early stage diagnosis of MM accurately and inexpensively. 

Test Principle

Protein electrophoresis is a well-established technique routinely used in clinical laboratories for screening serum and urine samples for protein abnormalities. The following protein fractions are obtained:

  • Gamma globulins
  • Beta-2 globulins
  • Beta-1 globulins
  • Alpha-2 globulins
  • Alpha-1 globulins
  • Albumin.

The M-protein is characterized by the presence of a sharp, well-defined band/peak on the electrophoresis pattern. Once the M-protein is identified (or suspected), electrophoresis is followed by immunological characterisation of the M-protein in both serum and urine by immunofixation or immunotyping using serum or urine immunoreaction with appropriate antisera. This second level testing enables the determination of the heavy chain (IgG, IgA, IgM, IgD or IgE) and/or light chain (kappa or lambda) involved. 

Test Indications

Serum and urine protein electrophoresis and their immunological characterisation are the gold standard for MM diagnosis. Quantitative measurement of the M-protein by electrophoresis is necessary to monitor the disease and to assess the patient’s response to treatment.

Sebia offers a full range of solutions to enable clinicians to provide optimal medical care for patients with MM and other monoclonal gammopathies. Ensuring high quality and traceable results, this full range of solutions, for both serum and urine investigations, can be adapted to all laboratory sizes. 

SEBIA assays available for this pathology