HAEMATOLOGY
urine of a subset of patients due to renal filtration.17
sFLC assays are therefore
particularly valuable for identifying cases of light chain myeloma or non-secretory myeloma, where other paraprotein diagnostic methods may fall short in terms of specificity, sensitivity, or both.18 The diagnostic challenges posed by non-secretory myeloma arise from the insufficient presence of measurable circulating biomarkers, which are often below the detection threshold of conventional detection methods. Fortunately, the sFLC assay offers a significant advantage in this context. The assay quantitatively measures the levels of free kappa (κ) and lambda (λ) light chains in the serum to identify abnormal κ/λ ratios, a key indicator of clonal plasma cell activity. Abnormal sFLC ratios have been observed in up to 70% of non-secretory myeloma cases, even when paraproteins are absent or only present in trace amounts. As a result, the sFLC assay has become an invaluable tool for identifying this rare and elusive MM subtype.19 Despite clear advantages, the adoption of sFLC assays for early diagnosis remains inconsistent, with many UK hospitals continuing to use these assays solely for monitoring disease progression, rather than for initial MM detection, contrary to NICE,16
BSH20
Unfortunately, even the symptoms of advanced MM are often subtle and can easily be mistaken for other conditions, leading to delayed diagnosis
and IMWG15 recommendations. This
highlights a gap between evidence- based scientific guidelines and their implementation in clinical practice.
Why early diagnosis matters Although the treatment landscape for MM has undergone a significant transformation over the last two decades – marked by the development of therapies such as proteasome inhibitors, immunomodulators and monoclonal antibodies – early diagnosis remains a crucial element of optimal patient management, and is essential for achieving improved outcomes. Advances in MM treatment, driven by a deeper understanding of its molecular biology, have dramatically extended median survival times from approximately three years to eight to ten years. However, MM remains a complex and heterogeneous disease, with survival rates still heavily influenced by the stage at which it is diagnosed.21
Proactive detection of MM gives clinicians more opportunities to intervene before complications such as renal failure or vertebral fractures arise, significantly improving patients’ quality of life and survival. In addition, studies have shown that early-stage MM is less genetically diverse than advanced MM,22
making
it more responsive to treatment. This means that treatment can begin with less aggressive strategies, reducing the potential for harmful side effects. Essentially, the earlier MM is identified, the more options are available to manage it effectively and prevent severe complications, thus maximising patient outcomes. From a healthcare economics perspective, timely diagnosis also reduces the need for expensive emergency treatments, such as vertebroplasty for spinal collapse or dialysis for renal failure.23
By preventing these
complications, the NHS could reduce overall costs by offsetting the additional
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