Significance of serum protein electrophoresis in diagnosing multiple myeloma: A retrospective study at a tertiary care centre
Article Sidebar
Main Article Content
https://orcid.org/0009-0004-7651-2050
Swetha Raghavendra Prasad
https://orcid.org/0009-0000-0727-4758
Dhivya Senthil Kumar
https://orcid.org/0009-0000-5216-4902
Sathya Selvarajan
https://orcid.org/0000-0002-6390-1522
Sowmya Krishnamurthy
https://orcid.org/0000-0002-3070-9411
Sridharan Kopula Sathyamurthy
https://orcid.org/0000-0003-0291-5637
Abstract
Multiple myeloma (MM) is a hematologic malignancy characterized by uncontrolled plasma cell proliferation in the bone marrow, initially asymptomatic, often causing symptoms like bone pain, anemia, renal dysfunction, and increased infection susceptibility. The study investigates the clinical significance of inconsistencies in albumin measurement methods in multiple myeloma patients, focusing on serum protein electrophoresis (SPEP) and the bromocresol green (BCG) assay. A comparative analysis was conducted to evaluate the differences between albumin levels measured by SPEP and BCG, exploring how these variations relate to disease severity and treatment decisions in MM patients. According to the results, SPEP albumin levels were significantly higher than BCG albumin levels in MM patients (p <0.001). This difference is clinically significant, as lower BCG albumin readings could overestimate disease severity, potentially leading to misclassification and affecting treatment decisions. Accurate albumin measurement is crucial for proper staging and prognosis in multiple myeloma. In conclusion, this highlights the need to integrate SPEP and biochemical markers for more precise diagnosis and timely intervention. While SPEP is essential for diagnosing MM and monitoring M-protein (also known as monoclonal immunoglobulin or paraprotein), the BCG method remains useful for staging and prognosis. Standardizing laboratory protocols and exploring novel biomarkers could improve MM diagnosis, ensuring more accurate disease classification and better patient management. Further research is needed to assess the long-term impact of these discrepancies on treatment outcomes and survival rates.
Downloads
Article Details
Copyright (c) 2025 Shrinidhi Sundar, Swetha Raghavendra Prasad , Dhivya Senthil Kumar, Sathya Selvarajan, Sowmya Krishnamurthy, Sridharan Kopula Sathyamurthy
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Albagoush SA, Shumway C, Azevedo AM. Multiple myeloma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534764/
Mikhael J, Bhutani M, Cole CE. Multiple myeloma for the primary care provider: A practical review to promote earlier diagnosis among diverse populations. Am J Med. 2023;136(1):33–41. https://doi.org/10.1016/j.amjmed.2022.08.030
Aksenova AY, Zhuk AS, Lada AG, Zotova IV, Stepchenkova EI, Kostroma II, et al. Genome instability in multiple myeloma: Facts and factors. Cancers. 2021;13(23):5949. https://doi.org/10.3390/cancers13235949
Giannakoulas N, Ntanasis-Stathopoulos I, Terpos E. The role of marrow microenvironment in the growth and development of malignant plasma cells in multiple myeloma. Int J Mol Sci. 2021;22(9):4462. https://doi.org/10.3390/ijms22094462
Prisi S, Khurana V, Saijpaul R, Verma R, Chandra L, Koner BC. Unraveling the possibilities of monoclonal protein migration, identification, and characterization in SPEP on capillary zone electrophoresis. J Lab Physicians. 2022; 14(4):505–10. https://doi.org/10.1055/s-0042-1744242
Intra J, Brivio R, Cappellani A, Minolfi V, Romano R, Spinoni N, et al. Monoclonal components in the alpha-2 region should not be neglected in capillary electrophoresis. Clin Chem Lab Med CCLM. 2021;59(4):e145–7. https://doi.org/10.1515/cclm-2020-1377
Zhang Y, Abdollahi A, Andolino C, Tomoo K, Foster BM, Aryal UK, et al. Performance evaluation of different albumin assays for the detection of an albuminemia. PLOS ONE. 2024;19(3):e0300130. https://doi.org/10.1371/journal.pone.0300130
Kim S, Berenson JR. Predicting outcomes and monitoring disease in patients with multiple myeloma. Clin Adv Hematol Oncol. 2023;21(9):484-493. Available from: https://pubmed.ncbi.nlm.nih.gov/37647495/
He H, Wang, Lingfeng, Wang, Xia, and Zhang M. Artificial intelligence in serum protein electrophoresis: History, state of the art, and perspective. Crit Rev Clin Lab Sci. 2024;61(3):226–40. https://doi.org/10.1080/10408363.2023.2274325
Vakiti A, Padala SA, Hashmi MF, Mewawalla P. Renal disease in monoclonal gammopathies. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499952/
Derudas D, Concu C, Durzu T, Piras D, Nemolato S, Liguori AM, et al. Mimicking multiple myeloma: The importance of the differential diagnosis. Arch Clin Med Case Rep. 2024;8(5):167–71. https://doi.org/10.26502/acmcr.96550683
Omar N, Madwani K, Moideen P, Manthei DM, Keren DF, Singh G. Accurate quantification of monoclonal immunoglobulins migrating in the beta region on protein electrophoresis. Lab Med. 2022;53(2):138–44. https://doi.org/10.1093/labmed/lmab055
L’Imperio V, Cazzaniga G, Vergani B, Smith AJ, Alberici F, Pagni F. Monoclonal gammopathy of renal significance: A molecular middle earth between oncology, nephrology, and pathology. Kidney Dis. 2022;8(6):446–57. https://doi.org/10.1159/000527056
Kitson AL, Taylor AS, Giacherio DA, Keren DF. Reflexing suspicious β-region findings on capillary serum protein electrophoresis to immunofixation or immunosubtraction for detecting monoclonal proteins. Am J Clin Pathol. 2022;157(2):171–9. https://doi.org/10.1093/ajcp/aqab108
Santos G, Turner AM. Alpha-1 antitrypsin deficiency: An update on clinical aspects of diagnosis and management. Fac Rev. 2020;9:1. https://doi.org/10.12703/b/9-1
Danalakshmi S. Monoclonal light chains with alpha 2 mobility on serum protein electrophoresis. EJIFCC. 2023;34(3):250–7. https://pmc.ncbi.nlm.nih.gov/articles/PMC10588080/
Squire JD, Leiding JW. Allergic and immunologic diseases [Internet]. Academic Press. 2022:725–35. https://doi.org/10.1016/B978-0-323-95061-9.00026-6
Kuriakose E, Narayanan UCS, Kuzhikandathil NS, Vasudevan A. A study on free light chain assay and serum immunofixation electrophoresis for the diagnosis of monoclonal gammopathies. Indian J Clin Biochem. 2019;34(1):76–81. https://doi.org/10.1007/s12291-017-0718-6
Pektaş G, Yılmaz F, Öncü Ş, Kızılkaya MB, Sadi G, Pektaş MB. Evaluation of current survival and prognostic factors in multiple myeloma: Staging ISS or R-ISS? Health Sci Q. 2025;5(1):65–74. https://doi.org/10.26900/hsq.2605
Lim SM, Wijeratne N, Choy KW, Nguyen TTH, Setiawan L, Loh TP. A review of clinical guidelines, laboratory recommendations and external quality assurance programs for monoclonal gammopathy testing. Crit Rev Clin Lab Sci. 2024;61(2):107–26. https://doi.org/10.1080/10408363.2023.2257306
Mihou D, Katodritou E, Zervas K. Multiple myeloma staging based on the combination of beta-2-microglobulin and albumin: The role of albumin in the model. Hematol Amst Neth. 2007;12(6):527–31. https://doi.org/10.1080/10245330701384161
Penickova S, Benyaich S, Ambar I, Cotton F. Reliability of albumin bromocresol green colorimetric method and clinical impact. Scand J Clin Lab Invest. 2024;84(7-8):1–7. https://doi.org/10.1080/00365513.2024.2420311
Zhou X, Lu Y, Xia J, Mao J, Wang J, Guo H. Association between baseline controlling nutritional status score and clinical outcomes of patients with multiple myeloma. Cancer Biomark. 2021;32(1):65–71. https://doi.org/10.3233/cbm-210073
