Multiple Myeloma Testing: Challenges of Urine Tests
Introduction
Did you know that studies show
Up to 95% of patients do not provide a 24-hour urine sample when a 24-hour urine Bence Jones Protein test (i.e. Free Light chains in urine) is requested, leading to delays in Multiple Myeloma diagnosis
Patients can develop clinical complications when diagnosis of Multiple Myeloma is delayed.
Speaker
Featured in this video
Wei-Hong Tay
Sales Development Manager & Medical Science Liaison, Binding Site, part of Thermo Fisher Scientific
What are the challenges with providing 24-hour urine samples?
Patients are asked to collect and store urine samples in large 3-liter bottles over a 24-hour period. The process of having to manage these large collection bottles is cumbersome and the challenge deters many patients from providing the sample to the laboratory for testing.
Studies show that compliance for 24-hour urine sample collections to investigate Bence Jones Proteins can be as little as < 5%. This means in more than 95% of cases there may not be a sample to analyse.
Even with active follow-up for up to 90 days from receipt of a blood sample, only 52% of patients provided the requested 24-hour urine sample.
24hr Urine Sample Provision for Bence Jones Proteins
No Chase Up
Active Chase Up for Urine Sample
What is the impact of not providing a 24-hour urine sample?
To help avoid diagnostic delays, request serum Free Light Chain testing over urine Protein Electrophoresis in Multiple Myeloma investigations
Enable more frequent and convenient monitoring of Multiple Myeloma patients
Monthly urine protein electrophoresis (UPE) testing is recommended alongside serum testing in the IMWG guidelines for monitoring Multiple Myeloma (MM) patients during active treatment3. However, a study by Foster et al.,4 demonstrated 24-hour urine tests are not consistently used in clinical practice, with only 27.7% of Multiple Myeloma and 15.2% of Light Chain Multiple Myeloma patients being followed by UPE, compared to 58.1% and 84.8% with serum free light chains (sFLC) respectively. Practical issues around the collection, storage and processing of 24-hour urine samples hinders their application in real-world settings.
Multiple Myeloma patients being monitored with sFLC were able to be tested more than twice as often than those by UPE. Patients monitored with sFLC tests had an average time between tests of 42 days for sFLC compared to 95 days for UPE.
Download this summary of publications to find out why you should order sFLC over UPE when investigating for Multiple Myeloma
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References
- Natsuhara KH, Huang CY, Knoche J, Arora S, Chung A, Martin T, et al. Significance of the pee-value: relevance of 24-hour urine studies for patients with myeloma. Leuk Lymphoma 2023 Apr 25:1-8. Epub 20230425 as doi: 10.1080/10428194.2023.2201365.
- Askari E. Adding value of serum-free light chain in assessing response and progression in multiple myeloma with measurable disease. Presented at IMS 2023:P-126a.
- Ludwig H, Miguel JS, Dimopoulos MA, Palumbo A, Garcia SR, Powles R, et al. International Myeloma Working Group recommendations for global myeloma care. Leukemia 2014 10/9/2013;28:5:981-92 as doi: leu2013293 [pii];10.1038/leu.2013.293 [doi].
- Foster RB, Tromanhauser M, Gayer C, Gonzales PK, Maignan K, Opong AS, et al. Approximating International Myeloma Working Group Uniform Response Criteria to Derive Response for Multiple Myeloma (MM) Patients Using Data from Electronic Health Records (EHR). Presented at ASH 2019 2019/11/13/;134:4727 as doi: https://doi.org/10.1182/blood-2019-127181
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