Diagnostic Value of Alkaline Phosphatase in Multiple Myeloma

Introduction to ALP and Myeloma

• High baseline bone-specific ALP (≥146 U/L) is a poor prognostic marker in myeloma patients, associated with worse survival, according to the European Society for Medical Oncology 1

Bone Markers and Treatment Response

• The International Myeloma Society recommends that routine use of biochemical bone markers for monitoring is not advised due to lack of prospective validation studies 2
• The National Comprehensive Cancer Network notes that bone formation markers like bone-specific alkaline phosphatase (BALP) have produced conflicting results but correlate with bone pain, lytic lesions, and fractures in some studies 3

Diagnostic Algorithms

• The American Society of Clinical Oncology suggests that if ALP is normal or low with lytic lesions present, there should be a high suspicion for multiple myeloma, and serum free light chain assay should be ordered 4