Laboratory Diagnosis of Multiple Myeloma at a Tertiary Care Center in Eastern India: A Retrospective Observational Study and Call for Homogenization

Serum and/or agarose (AGE) and/or capillary (CZE) electrophoresis, free light chain assay (sFLC) with free light chain ratio, immunotyping by either immunofixation electrophoresis (IFE) or immunosubtraction-CZE, and bone marrow (BM) evaluation are four cornerstones in the diagnosis and follow-up monitoring in subjects with multiple myeloma (MM). To describe the trends in MM diagnosis at our center and review the existing practices as per guidelines. Serum AGE and/or CZE electrophoretic and reporting patterns in BM-proven MM subjects (2023–2025) were retrospectively reviewed and correlated with clinico-radiological and routine biochemical parameters. The performance characteristics of AGE and CZE were tested, monoclonal protein (M-protein) estimations by perpendicular drop (PD) and tangent skimming (TS) methods were compared in a subset, and Bland–Altman analysis was used to assess the performance of different testing platforms. Ninety-three AGE-tested MM subjects (75 new, 18 follow-up, M/F: 60/33, age: 60 years, range: 30–85) showed variation amongst reporting consultants pertaining to nomenclature used, inclusion of interpretative comments, and further suggestions. There was reasonable agreement between serum albumin (Alb) estimation by conventional and electrophoretic techniques as well as M-protein by AGE and CZE. M-protein estimation by the PD method gave higher concentration than by the TS method in CZE (n = 13). BM evaluation with judicious use of immunohistochemistry was diagnostic. sFLC and IFE, at present not available in-house, were outsourced to referral laboratory. The current trend in myeloma testing at our center includes serum AGE, BM morphology, and outsourced sFLC with or without reflex IFE. AGE continues to be popular among clinical biochemistry laboratories, whereas CZE is gaining popularity among referral and clinical laboratories. Our experience suggests for a homogenized, cost-effective, basic practical minimum, diagnostic panel, and a standardized reporting format for myeloma cases in a resource-constrained setting.