Audit of the Prevalence of Noncorrelation of Immunofixation with Protein Electrophoresis and Serum Free Light Chain Assays in Multiple Myeloma in a Tertiary Cancer Care Center

Multiple myeloma (MM) is diagnosed and monitored by correlating panel of test results including serum Protein electrophoresis (SPE), Immunofixation electrophoresis (IFE), serum Free Light chain (sFLC) measurements. This audit is aimed to evaluate the prevalence of non-correlation and discrepancies amongst the three investigations (SPE/IFE/sFLC) for assessment of MM. 106 MM patients were reviewed over 16 months in a tertiary cancer care center by the availability of 3 serum test results (SPE/IFE/sFLC). Patients were divided into 2 groups: group1, newly diagnosed MM patients who were yet to receive myeloma specific treatment (n = 48); and group2, already diagnosed MM patients on treatment and followup (n = 58). Treatment modalities included stem cell transplantation and standard chemotherapy regimens. Non-correlation between the three test results (IFE/SPE/sFLC) was observed (21% in group1 and 45% in group2). Three types of discrepancies were detected as follows: (a) IFE showing less number of restriction bands as compared to SPE (8.6% patients in group2); (b) SPE/IFE negative with an abnormal sFLC ratio (12.5% patients in group1 and 13.7% in group2); (c) SPE/IFE positive but normal sFLC ratio (8% in group1 and 22% in group2). To conclude, IFE may sometimes provide information that does not always correlate with either of the SPE or sFLC results due to different sensitivities, antigen–antibody interactions, or treatment. Hence, SPE plus sFLC may be more useful particularly for patients on follow-up while IFE plus sFLC may help screen the new patients. The judicious selection of the biochemical assays can effectively reduce the treatment cost in a developing country like India.