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Screening for and diagnosis of monoclonal gammopathy
  1. Yuh Ping Chong1,
  2. Say Min Lim2,
  3. Tze Ping Loh3,
  4. Peter Mollee4,5,
  5. Nilika Wijeratne6,7,8,
  6. Kay Weng Choy9
  1. 1 School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
  2. 2 Department of Pathology, Hospital Teluk Intan, Teluk Intan, Malaysia
  3. 3 Department of Laboratory Medicine, National University Hospital, Singapore
  4. 4 Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  5. 5 School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  6. 6 Dorevitch Pathology, Heidelberg, Victoria, Australia
  7. 7 School of Clinical Sciences at Monash Health, Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  8. 8 Eastern Health Pathology, Eastern Health, Box Hill, Victoria, Australia
  9. 9 Department of Pathology, Northern Health, Epping, Victoria, Australia
  1. Correspondence to Dr Kay Weng Choy, Department of Pathology, Northern Health, Epping, Victoria, Australia; kayweng.choy{at}


Monoclonal gammopathy is a spectrum of disorders characterised by clonal proliferation of plasma cells or lymphocytes, which produce abnormal immunoglobulin or its components (monoclonal proteins). Monoclonal gammopathies are often categorised as low-tumour-burden diseases (eg, amyloid light chain (AL) amyloidosis), premalignant disorders (such as monoclonal gammopathy of undetermined significance and smouldering multiple myeloma), and malignancies (eg, multiple myeloma and Waldenström’s macroglobulinaemia). Such diversity of concentration and structure makes monoclonal protein a challenging clonal marker. This article provides an overview on initial laboratory testing of monoclonal gammopathy to guide clinicians and laboratory professionals in the selection and interpretation of appropriate investigations.

  • Multiple Myeloma
  • Immunoglobulins
  • Biomarkers, Tumor

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  • Handling editor Patrick J Twomey.

  • Contributors YPC and KWC wrote the initial draft of the manuscript. SML, TPL, PM and NW revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.