[PubMed] [Google Scholar] 9. may be present, it is important to know which assay was used to derive the serum FLC levels. (iii) What is the relative level of sensitivity of serum FLC screening compared with urine checks for monoclonal proteins? At many centers, UPEP or UIFE remains the test of choice for screening for light chain monoclonal gammopathy; however, serum FLC assay is being progressively used both for screening and for assessment of disease response. The International Myeloma Working Group has recommended that SPEP, IFE, and serum FLC assay is definitely a sufficient testing panel for monoclonal gammopathy except for AL amyloidosis, where it is recommended that screening should also include urine IFE.12 Probably the most pragmatic approach is to use a serum or urine test for diagnostic purposes, but if the test is negative and the analysis MC-GGFG-DX8951 of MGRS is possible then the alternative test should also be applied. This approach recognizes that a false negative test by either serum or urine is possible in patients having a low-level light chain clone. The following studies offered data that included a direct assessment between serum FLC assay and urinary screening. Although these studies possess limitations, they all display that serum FLC screening is more sensitive. (a) Nowrousian 31 (Supplementary 1): 151C200, 2013. Footnotes DISCLOSURE PWS is an advisory table member of ZS Pharma, and has been a consultant to The Binding Site Group, Birmingham, UK. Personal computer is definitely a medical advisor to the Binding Site Group, Birmingham, UK. The remaining authors declared no competing interests. Recommendations 1. Kyle RA, Therneau TM, Rajkumar SV, et al. Prevalence of monoclonal gammopathy of undetermined significance. N Engl J Med. 2006;354:1362C1369. [PubMed] [Google Scholar] 2. Dispenzieri A, Katzmann JA, Kyle RA, et al. Prevalence and risk of progression of light-chain monoclonal MC-GGFG-DX8951 gammopathy of undetermined significance: a retrospective population-based cohort study. Lancet. 2010;375:1721C1728. [PMC free article] [PubMed] [Google Scholar] 3. Leung N, Bridoux F, Hutchison CA, et al. Monoclonal gammopathy of renal MDS1 significance: when MGUS is definitely no longer undetermined or insignificant. MC-GGFG-DX8951 Blood. 2012;120:4292C4295. [PubMed] [Google Scholar] 4. Beetham R, Wassell J, Wallage MJ, et al. Can serum free light chains replace urine electrophoresis in the detection of monoclonal gammopathies? Ann Clin Biochem. 2007;44:516C522. [PubMed] [Google Scholar] 5. Hutchison CA, Harding S, Hewins P, et al. Quantitative assessment of serum and urinary polyclonal free light chains in individuals with chronic kidney disease. Clin J Am Soc Nephrol. 2008;3:1684C1690. [PMC free article] [PubMed] [Google Scholar] 6. Holding S, Spradbery D, Hoole R, et al. Use of serum free light chain analysis and urine protein electrophoresis for detection of monoclonal gammopathies. Clin Chem Lab Med. 2011;49:83C88. [PubMed] [Google Scholar] 7. Marshall T, Williams KM. Electrophoretic analysis of Bence Jones proteinuria. Electrophoresis. 1999;20:1307C1324. [PubMed] [Google Scholar] 8. Graziani M, Merlini G, Petrini C, et al. Recommendations for the analysis of Bence Jones protein. Clin Chem Lab Med. 2003;41:338C346. [PubMed] [Google Scholar] 9. te Velthuis H, Knop I, Stam P, et al. N Latex FLC – fresh monoclonal high-performance assays for the dedication of free light chain kappa and lambda. Clin Chem Lab Med. 2011;49:1323C1332. [PubMed] [Google Scholar] 10. Mollee P, Tate J, Pretorius CJ. Evaluation of the N Latex free light chain assay in the analysis and monitoring of AL amyloidosis. Clin Chem Lab Med. 2013;51:2303C2310. [PubMed] [Google Scholar] 11. Campbell JP, Cobbold M, Wang Y, et al. Development of a highly-sensitive multi-plex assay using monoclonal antibodies for the simultaneous measurement of kappa and lambda immunoglobulin free light chains in serum and urine. J Immunol Methods. 2013;391:1C13. [PubMed] [Google Scholar] 12. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group recommendations for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009;23:215C224. [PubMed] [Google Scholar] 13. Nowrousian MR, Brandhorst D, Sammet C, et al. Serum free light chain analysis and urine immunofixation electrophoresis in individuals with multiple myeloma. Clin Malignancy Res. 2005;11:8706C8714. [PubMed] [Google Scholar] 14. Katzmann JA, Dispenzieri A, Kyle RA, et al. Removal.
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