Multiple Myeloma: Likelihood Ratios

Introduction: Multiple myeloma is a plasma cell neoplasm producing a large amount of an immunoglobulin (IgG) causing end-organ damage. In particular, the patient must meet the following 3 criteria:

Presence of a monoclonal protein in the serum and/or urine

Presence of monoclonal plasma cells in the bone marrow >10%

Presence of end-organ damage: hypercalcemia, renal insufficiency, anemia, or lytic bone lesions

Diagnosis of a monoclonal proteinopathy proceeds with SPEP, UPEP, free light chains (FLC).

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Tags: Hematologic Neoplasm Tag this Diagnosis.

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Multiple Myeloma	10%
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The likelihood ratios of findings for Multiple Myeloma are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding	+LR	-LR	Comments, Study
SPEP and FLC	100	0	Study: Ann Clin Lab Sci. 2006 Spring;36(2):157-62. PMID: 16682511
Serum Free Light Chains Duplicate	44	0.1	Patients with k/l ratios >1.65 or <0.26 are identified as producing clonal {kappa} or {lambda} FLCs, respectively. Study: Ann Clin Lab Sci. 2006 Spring;36(2):157-62. PMID: 16682511
SPEP	3.4	0.4	aka Serum Protein Electrophoresis The presence of one or more distinct peaks not corresponding to the usual protein bands in the gamma or beta globulin regions indicated the possible presence of a monoclonal or polyclonal gammopathy. Study: Ann Clin Lab Sci. 2006 Spring;36(2):157-62. PMID: 16682511

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Serum Immunofixation Electrophoresis	Sensitivity = 93%		specificity not assessed. For patients defined by abnormal urine immunofixation electrophoresis. Study: Mayo Clin Proc. 2006 Dec;81(12):1575-8. PMID: 17165636
Proteinuria	Sensitivity = 88%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
X-Ray	Sensitivity = 79%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
UPEP	Sensitivity = 75%		globulin spike specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
Renal Insufficiency	Sensitivity = 55%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
Bence-Jones Proteinuria	Sensitivity = 49%		monoclonal light chains in urine specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
Hypercalcemia	Sensitivity = 30%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
Palpable Liver	Sensitivity = 21%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
Hypogammaglobulinemia	Sensitivity = 9%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582
Palpable Spleen	Sensitivity = 5%		specificity not assessed Study: Mayo Clin Proc. 1975 Jan;50(1):29-40. PMID: 1110582

Findings With Unspecified Accuracy

Serum Free Light Chains
Duplicate

No accuracy specified.

Study: no study specified.

Serum Free Light Chains
Duplicate

No accuracy specified.

Study: no study specified.