Monoclonal gammopathy (MG) encompasses a diverse group of disorders characterized by the secretion of monoclonal im munoglobulins or their light-chain components. The incidence of multiple myeloma (MM) in South Korea is rapidly increasing,
and it is important to be aware of its initial clinical presentations and the most efficient laboratory algorithms for early detection.
Serum protein electrophoresis (SPE) and urine protein electrophoresis (UPE) are the primary screening tests for patients with clin ically suspected MM or amyloid light-chain amyloidosis; these tests are reimbursed in South Korea. We reviewed clinical studies
that applied national and international guidelines to evaluate test panels for early detection of MGs, including MM. The serum free
light chain (sFLC) with SPE panel is recommended for the initial work up for diagnosis of MGs. In the case of a normal SPE, sFLC
should be measured subsequently, so as not to miss the presence of M-protein. Use of this screening panel avoids medical expenses
related to delayed diagnosis. Guidelines and recommendations suggest that no single method (SPE, serum immunofixation electro phoresis, sFLC, or UPE) should be used to exclude a diagnosis of MM. We believe that a screening test panel comprising SPE plus
sFLC will increase the rate of early and accurate diagnosis of MM and related disorders.