Plasma cell disorders (PCDs) are identified in the clinical lab by detecting the monoclonal immunoglobulin (M-protein) which they produce. Traditionally, serum protein electrophoresis methods have been utilized to detect and isotype M-proteins. Increasing demands to detect low-level disease and new therapeutic monoclonal immunoglobulin treatments have stretched the electrophoretic methods to their analytical limits. Newer techniques based on mass spectrometry (MS) are emerging which have improved clinical and analytical performance. MS is gaining traction into clinical laboratories, and has replaced immunofixation electrophoresis (IFE) in routine practice at one institution. The International Myeloma Working Group (IMWG) Mass Spectrometry Committee reviewed the literature in order to summarize current data and to make recommendations regarding the role of mass spectrometric methods in diagnosing and monitoring patients with myeloma and related disorders. Current literature demonstrates that immune-enrichment of immunoglobulins coupled to intact light chain MALDI-TOF MS has clinical characteristics equivalent in performance to IFE with added benefits of detecting additional risk factors for PCDs, differentiating M-protein from therapeutic antibodies, and is a suitable replacement for IFE for diagnosing and monitoring multiple myeloma and related PCDs. In this paper we discuss the IMWG recommendations for the use of MS in PCDs.

Cancer Science Institute of Singapore NUS Singapore Singapore

Clinica Universidad de Navarra Centro de Investigacion Medica Aplicada IDISNA Pamplona Spain

Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway

Department of Hematologic Oncology and Blood Disorders Levine Cancer Institute Atrium Health Charlotte NC USA

Department of Hematology Cedars Sinai Outpatient Cancer Center Los Angeles CA USA

Department of Hematology Mayo Clinic Rochester MN USA

Department of Hematology St Olav's University Hospital Trondheim Norway

Department of Hematooncology University Hospital Ostrava and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN USA

Division of Hematology Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA USA

Faculty of Medicine University of Iceland Reykjavík Iceland

Hospital Universitario de Salamanca Instituto de Investigación Biomédica de Salamanca Salamanca Spain

National University Cancer Institute Singapore Singapore

Yong Loo Lin School of Medicine NUS Singapore Singapore

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