What is the significance of mass spectrometry in measuring myeloma protein levels?

this week's ask Dr Dury comes from a patient who wants to know more about mass spectrometry as a test for measuring the level of the Myoma protein in the blood and so this is uh actually a very important question mass spectrometry is a new method which allows us to measure much lower levels of Myoma protein in the blood it's a more sensitive test than using serum protein electroforesis and imuno fixation so spep and what's called if and so we are excited to have the possibility to have this new

Mass spectrometry uh testing uh to give you an idea if one looks at uh patients who have had what appears to be a complete remission using current standard testing with esep and amino fixation about 20 % of those patients will still have a positive result with mass spectrometry so with a more sensitive test you can pick up more patients who may have a low level of residual disease and what we've learned is that this is important because among patients who appear to have a complete remission thes

e individuals who are positive with with mass spec are the ones who have a shorter response to the treatment and and stay in remission for a lesser period of time so this is a a poorer outcome if this massp test is positive and so this is one advantage of mass spectrometry the mass spectrometry can also be used in more of a routine uh fashion uh to initially detect the Myoma protein and track it uh with monitoring on an ongoing basis and this can be uh a helpful and simple way to evaluate my in

addition what has become quite important is that using mass spectrometry you can distinguish between the monoclonal protein which is coming from the Myoma and the monoclonal protein which may be given as part of a treatment which is also a monoclonal protein so this has become confusing when a patient is taking DaRuMa for example anti cd38 monoclonal antibody this could be confus fused with a low level of Myoma protein because both would show a low level spike in the blood but using mass spectro

metry you can tell if the spike is Myoma or if it's DaRuMa for example so this is important in addition there is a change that can occur on monoclonal proteins called glycosilation This is a biochemical change that can Surface on the on on the protein and this is linked to a tendency for amalo formation where the uh proteins actually are more likely to Crosslink if they have this glycosilation factor and so again this is something that can be detected and distinguished using mass spectrometry so

the bottom line is that this is a new technique for sensitive monitoring uh hopefully it will become more widely available in the coming months right now samples can be sent to the Mayo Clinic but it's hoped that some large groups like uh lab core and the like will will also be making this testing available in in the near future and so with the availability of testing this can be uh a useful test for a variety of things including both diagnosis uh monitoring and uh particularly to detect patien

ts who will uh do uh particularly uh well