Multiple Myeloma Cascade With Reflex to sIFE and sFLC

CPT: 84155; 84165
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Test Includes

A Serum Protein Electrophoresis (SPEP) test is first run. If the SPEP is:

1. Positive (i.e., M-Protein present), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (e.g., "IgG Kappa"). This finding will be reported and no further reflex testing will occur.

2. Negative (i.e., no M-Protein seen), a serum Free Light Chain (sFLC) test is automatically ordered and run (at additional charge). Then:

• If the sFLC is Positive (i.e., abnormal K/L ratio), a serum Immunofixation (sIFE) test is automatically ordered and run (at additional charge). This reflexed test serves to identify the M-protein's heavy and light chain components (e.g., "IgG Kappa"). This finding will be reported and no further reflex testing will occur.

• If the sFLC is Negative (i.e., no abnormal K/L ratio), no further reflex testing will occur. A recommendation comment will be added to the report to "Consider ordering urine Immunofixation (uIFE) to rule out Amyloidosis (AL)."


Expected Turnaround Time

3 - 5 days



Specimen Requirements


Specimen

Serum


Volume

5 mL


Minimum Volume

3 mL


Container

Red-top tube or gel-barrier tube


Storage Instructions

Refrigerate at 2°C to 8°C.


Stability Requirements

Temperature

Period

Room temperature

3 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3


Causes for Rejection

Hemolysis; plasma instead of serum


Test Details


Use

To maximize the clinical sensitivity of Serum Protein Electrophoresis (SPEP) when screening for plasma cell dyscrasias.


Methodology

SPEP: Protein electrophoresis on agarose media; IFE: Electrophoresis followed by immunodiffusion against monospecific antisera to immunoglobulin and individual heavy and light chains; Ig Quant: turbidimetric quantitation of IgG, IgA, and IgM; sFLC: turbidimetric quantitation


Additional Information

The analytical sensitivity of the commonly used serum tests for Multiple Myeloma (MM) screening is: SPEP < sIFE < sFLC with SPEP being the least sensitive and sFLC being the most sensitive detector of M-proteins.1

According to the International Myeloma Working Group (IMWG) guidelines, addition of sFLC and IFE to SPEP can prevent false negatives and increases the detection of multiple myeloma to >99%.2


Footnotes

1. Katzmann, JA. Screening panels for monoclonal gammopathies: time to change. Clin Biochem Rev. 2009 Aug;30(3):105-111.19841692
2. Dispenzieri A, Kyle R, Merlini G, et al. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia. 2009 Feb;23(2):215-224.19020545

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
123200 Multiple Myeloma Cascade 001073 Protein, Total g/dL 2885-2
123200 Multiple Myeloma Cascade 001488 Albumin g/dL 2862-1
123200 Multiple Myeloma Cascade 001489 Alpha-1-Globulin g/dL 2865-4
123200 Multiple Myeloma Cascade 001490 Alpha-2-Globulin g/dL 2868-8
123200 Multiple Myeloma Cascade 001491 Beta Globulin g/dL 2871-2
123200 Multiple Myeloma Cascade 001492 Gamma Globulin g/dL 2874-6
123200 Multiple Myeloma Cascade 001493 M-Spike g/dL 33358-3
123200 Multiple Myeloma Cascade 011052 Globulin, Total g/dL 10834-0
123200 Multiple Myeloma Cascade 011149 A/G Ratio 1759-0
123200 Multiple Myeloma Cascade 011150 Please note: 77202-0
123200 Multiple Myeloma Cascade 123201 Reflex Testing N/A
123200 Multiple Myeloma Cascade 123203 MM Cascade Reflex Storage N/A
123200 Multiple Myeloma Cascade 001498 PDF 11502-2
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001776 Immunoglobulin G, Qn, Serum mg/dL 2465-3
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001784 Immunoglobulin A, Qn, Serum mg/dL 2458-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 001792 Immunoglobulin M, Qn, Serum mg/dL 2472-9
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 001496 Immunofixation Reflex, Serum 149519 Immunofixation Result, Serum 13169-8
Reflex 2 149532 Immunofixation Interp.,Sr 149532 Immunofixation Interp.,Sr 13169-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121138 Free Kappa Lt Chains,S mg/L 36916-5
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121139 Free Lambda Lt Chains,S mg/L 33944-0
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 2 001496 Immunofixation Reflex, Serum 001776 Immunoglobulin G, Qn, Serum mg/dL 2465-3
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 2 001496 Immunofixation Reflex, Serum 001784 Immunoglobulin A, Qn, Serum mg/dL 2458-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 2 001496 Immunofixation Reflex, Serum 001792 Immunoglobulin M, Qn, Serum mg/dL 2472-9
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 2 001496 Immunofixation Reflex, Serum 149519 Immunofixation Result, Serum 13169-8
Reflex 3 149532 Immunofixation Interp.,Sr 149532 Immunofixation Interp.,Sr 13169-8
Reflex Table for Reflex Testing
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 123202 Free K+L Lt Chains,Qn,S 121141 Kappa/Lambda Ratio,S 48378-4
Reflex 2 123303 Comment: 123303 Comment: N/A

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