Abstract P05: Testing patterns and referrals for monoclonal protein detection at John Peter Smith hospital
Authors: Athipatla Kavya , Howell Melissa , Lingam Anuradha , Narra Kayani 
Published: March 2024

Abstract
Background: Multiple myeloma (MM) is an incurable disease. Blacks have a higher incidence of MM and are diagnosed at a younger age compared to other populations. Safety-net hospitals (SNH) treat a high proportion of Black patients. Early detection of myeloma is important to prevent permanent organ dysfunction. Serum monoclonal protein testing using expanded panel aids in the diagnosis and monitoring of monoclonal gammopathies. This test result has 16 discrete components and any out-of-range value can be confusing to the ordering providers, triggering referrals to hematology oncology (hemonc). We sought to identify the testing and referral patterns at John Peter Smith (JPS) Hospital, a SNH in North Texas. Methods: Data was obtained from JPS Data Analytics and Reporting department. All serum monoclonal protein expanded panel (LAB174) orders and results for patients tested from 1-1-2022 to 12-31-2022 were abstracted from EPIC EMR. Demographic information was collected along with details about ordering providers and referrals. We sorted the data and excluded all orders by oncology providers as well as all inpatient orders. Data analysis was completed using Excel. Results: A total of 1063 tests were performed on 1026 patients. 39% were Non-Hispanic White (NHW), 36% were Black, and 13% were Hispanic. Median age was 57 years. Monoclonal band was seen in 143 (13%) samples; immunoglobulin (IG) kappa (k) 59, IG lambda (λ) 68, both IG k and IG λ 9. Results with gamma (γ) and beta (β) band were seen in 22 and 3 respectively. Measurable k band (&gt;0.1 g/dL) was seen in 12 tests, &gt; 1 g/dL in 5, and &gt; 3 g/dL in only 1 test. Measurable λ band seen in 9 tests, &gt; 1 g/dL in 3, and &gt; 3 g/dL in no tests. Serum protein electrophoresis (SPEP) was normal in 525, and immunofixation (IFE) was normal in 507. Polyclonal SPEP was noted in 169 tests. Hypogammaglobinemia was seen in 11. 72 out of 369 (20%) Blacks had abnormal bands vs 47 out of 397 (12%) NHW. Two-tailed t-test was significant at p-value 0.00327. Referrals were generated to hemonc in 201 patients. Rheumatology accounted for 19% of tests, nephrology 18%, neurology 19%, and remaining were from primary care and other specialties. 212 patients were referred to hematology oncology using ICD10 diagnosis code R77.8. Rheumatologists referred 48 patients, which is 25% of all patients that they tested. Referrals from neurology: 39 (20%) and nephrology: 25 (13%). Conclusions: At JPS, clinical care providers are conducting tests to identify precursor conditions to myeloma. The test positivity rate was 13% in the non-oncology outpatient setting. Blacks had a higher percentage of positivity, reinforcing the need for a higher index of suspicion. The complexity of the test results, however, is overwhelming to the ordering providers, triggering referrals to the hemonc division, prompting recruitment and training of midlevel providers within hemonc to ensure proper monitoring of patients with precursor conditions. JPS Office of Clinical Research is planning to participate in early detection clinical trials for myeloma.
Citation Format: Kavya Athipatla, Melissa Howell, Anuradha Lingam, Kayani Narra. Testing patterns and referrals for monoclonal protein detection at John Peter Smith hospital [abstract]. In: Proceedings of the Blood Cancer Discovery Symposium; 2024 Mar 4-6; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2024;5(2_Suppl):Abstract nr P05.