Draft of the recommendations made by the “Forlì” group as a result of the experiments carried out since it was established in 1993.
It specifies the minimum performance levels of each method to be used in the study of BJPs.

Recommendations made by the “Liguria” group as a result of its experiments, placing particular emphasis on a series of considerations to be taken into account when reporting results.

Proposal of operative protocol based on the use of liquid-phase immunoprecipitation (nephelometry or turbidimetry) with specific anti-free light chain antiserums (hidden determinants) of immunoglobulins as a first-level test, followed up by immunofixation (IFE) as a confirmation test, to determine whether the FLCs present are monoclonal, i.e. Bence Jones (BJP), or polyclonal.

Revision of the typical urinary immunofixation patterns found in the BJP study.

SIBioC BJP guidelines.
In short, it proposes immunofixation as the preferred method in the search for BJPs, advising against other methods.

Considerations and comments by L. Massaro on the above document.

Reply to the above letter.

Recent review of the guidelines published by the protein study group of the SIBioC, where, as a novelty regarding the 2001 Edition (http://www.sibioc.it/linee/14.pdf), it considers, as an alternative to the classic immunoelectrophoretic methods (IFE), the use of immunochemical methods (nephelometry or turbidimetry) as screening techniques for indicating the presence of BJP.

CAP guidelines (College of American pathologists) for patients with monoclonal gammopathies.
In reference to the determining of Bence Jones proteinuria, the guidelines recommend that in all patients with a suspected monoclonal gammopathy, “the presence, type and daily excretion of monoclonal free light chains must be investigated.”
Patient monitoring must include the study of the changes in the level of the monoclonal component in serum and in urine, and must be carried out every one or two months in patients with evident disease (multiple myeloma, Waldenström, Amyloidosis AL, etc.) and at least once a year in patients with MGUS (Monoclonal Gammopathy of Unknown Significance).

Exhibition of conclusions and comments by Dr. Keren regarding the conference (sponsored by the CAP, among others), which culminated in the adoption at national level (USA) of the guidelines for the evaluation of patients with monoclonal gammopathy.
The conference focused on answering the following three questions:
- Which patients should be evaluated for the presence of a monoclonal (M) protein?
- What types of specimens should be studied, and how often should they be used to follow patients with M-proteins?
- Which laboratory methods should be used to detect, identify and follow M-proteins?

This is the first of the articles selected for the 32nd CAP Consensus Conference on Monoclonal Gammopathies, which culminated in the preparation of the guidelines.
It gives the objectives of the conference and introduces the subsequent articles.

Article selected for the 32nd CAP Consensus Conference on monoclonal gammopathies, which culminated in the preparation of the guidelines.
It classifies the different monoclonal gammopathies, highlighting the importance of laboratory studies (in particular electrophoretic studies) for said differentiation.

Article selected for the 32nd CAP Consensus Conference on monoclonal gammopathies, which culminated in the preparation of the guidelines.
It lists the tests to be carried out on patients in whom a monoclonal gammopathy is suspected.

Article selected for the 32nd CAP Consensus Conference on monoclonal gammopathies, which culminated in the preparation of the guidelines.
It gives recommendations for the analysis of crioglobulins.

Article selected for the 32nd CAP Consensus Conference on monoclonal gammopathies, which culminated in the preparation of the guidelines.
Review of the performances and usefulness of the methods available for the screening, characterisation and quantification of monoclonal proteins.

Recent review of the guidelines published by the protein study group of the SIBioC, where, as a novelty regarding the 2001 Edition (http://www.sibioc.it/linee/14.pdf), it considers, as an alternative to the classic immunoelectrophoretic methods (IFE), the use of immunochemical methods (nephelometry or turbidimetry) as screening techniques for indicating the presence of BJP..

NCCM (National Comprehensive Cancer Network) guidelines, which review the diagnosis, treatment and monitoring of multiple myeloma, primary amyloidosis and Waldenström’s macroglobulinaemia.
In reference to Bence Jones proteinuria, they recommend the inclusion of their quantitative and qualitative determination as part of the initial studies to be made for the diagnosis of multiple myeloma.

SEQC document recently published in its magazine, giving a review of the clinical usefulness of BJP determination and the methods available.

UK Myeloma Forum guidelines for patients with Multiple Myeloma.
The tests recommended for patients suspected of having myeloma include the qualitative and quantitative determination of Bence Jones proteinuria.
The monitoring of patients with indolent myeloma (or similar) must include the quantitative determination of paraprotein in serum and urine every three months in order to control the appearance of signs of the advancement of the disease which would recommend the initiation or modification of treatment.

UK Myeloma Forum guidelines for patients with solitary plasmacytoma (osseous or extramedullary), complementary to that of multiple myeloma.
Among other studies, it sets forth that for all patients both serum and urine must be investigated for the presence of a monoclonal component which, if greater than a certain level, can lead to the suspicion of multiple myeloma.

UK Myeloma Forum guidelines for patients with chronic lymphoid leukaemia, complementary to that of multiple myeloma.

UK Myeloma Forum guidelines for patients with AL Amyloidosis, complementary to that of multiple myeloma.

BSCH guidelines for Waldenström’s macroglobulinaemia.

UK Myeloma Forum recommendations for the study of paraproteins.
Emphasis is placed on the fact that in the laboratory investigation of B cell dyscrasia it is essential to study serum and urine, since the presence of Bence Jones proteins (monoclonal FLCs) in urine suggests malignancy and may be the only tumour marker present.