Evaluating Trends in Diagnostic and Prognostic Testing for Multiple Myeloma

A battery of diagnostic and prognostic testing is recommended by both the NCCN and the International Myeloma Working Group (IMWG) at the time of diagnosis of myeloma. It has been our observation that many patients referred for Autologous Stem Cell Transplant (ASCT) to our center have not had a complete myeloma workup. In this report, we attempt to quantify the adherence to recommended guidelines for the workup of myeloma.

We reviewed the records of all patients with a diagnosis of myeloma referred to our center for ASCT between 2006 and 2011. We looked for the following tests at the time of diagnosis: bone marrow biopsy, SPEP, 24hr urine for Bence-Jones proteinuria, serum β2 microglobulin, skeletal survey, serum free light chains, serum albumin and myeloma FISH panel. We used descriptive statistics to evaluate our results.

There were a total of 64 patients who underwent an ASCT in our center between 2006 and 2011. Of these 64 patients, 9 patients were excluded from this review due to incomplete records. At the time of initial diagnosis, the most commonly obtained tests included an albumin level (55/55, 100%), SPEP (54/55, 98%), bone marrow biopsy (52/55, 95%), skeletal survey (52/55, 95%), standard cytogenetics (47/55, 85%), and β2-microglobulin (46/55, 84%). The most commonly omitted studies included the myeloma FISH panel (26/55, 47%), 24-hour urine for Bence-Jones protein (30/55, 55%), and serum free light chains (37/55, 67%). Compliance with the use of serum free light chain assay improved over time, while the frequency of obtaining a myeloma FISH panel remains relatively low and the frequency of obtaining a 24-hour urine for Bence-Jones protein decreased (Tables 1 and 2).

The most commonly omitted studies were the serum free light chains, 24hr urine and myeloma FISH panel. When assessed over time, compliance increased with the ordering of the SFLC assay, stable for the myeloma FISH panel but decreased for the 24hr urine for Bence-Jones protein. This trend reflects the perception that the serum free light chain assay is replacing the 24hr urine for Bence-Jones proteinuria. Referring community physicians need further education on the ordering of initial diagnostic and prognostic tests for multiple myeloma.

No relevant conflicts of interest to declare.