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Reading a serum electrophoresis report for myeloma | CION Cancer Clinics
A serum protein electrophoresis (SPEP) report sorts your blood proteins into bands. The line that matters for myeloma is the comment: whether a narrow M-band, or M-spike, was seen in the gamma or beta region. A spike means one clone of plasma cells is making too much of one antibody. Most found by chance are MGUS, not myeloma. This page walks through the report and what should follow. At CION Cancer Clinics, our haematology team plans myeloma and lymphoma care with you, discussed at a tumour board and explained in plain words.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What does a serum electrophoresis report show?
- How do you read the report line by line?
- Is it a narrow spike or a broad rise?
- What might the pathologist's comment say?
- An M-band was found. What should you do now?
- What do people fear wrongly about this report?
- Which short forms will you see?
- Common questions about serum electrophoresis
The short answer
What does a serum electrophoresis report show?
Serum protein electrophoresis, often printed as SPEP, sorts the proteins in your blood into bands and measures each one. For myeloma, the line that matters is whether there is a narrow, sharp band called an M-band or M-spike, which suggests one group of plasma cells is making too much of one antibody.
How the test works
A drop of serum, the clear part of blood, is placed on a gel and an electric current is passed through it. Proteins move different distances depending on their size and charge. They settle into five or six bands: albumin, alpha-1, alpha-2, beta and gamma. A machine then traces the bands as a graph with peaks.
Where myeloma shows up
Antibodies mostly sit in the gamma band, and sometimes in the beta band. Normal antibodies are made by many different plasma cells, so they form a low, wide hump. Antibody from a single clone is identical, so it piles up in one narrow peak, like a church spire on the graph.
What the report alone cannot do
SPEP can show a spike and measure it. It cannot name the antibody type, and it cannot say whether the spike is harmless MGUS or myeloma. Those answers need immunofixation, a free light chain test, other blood tests and often a bone marrow test.
Top to bottom
How do you read the report line by line?
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Total protein
All the protein in the serum added together. It can be high when a large M-protein is present, but it is also affected by dehydration, liver disease and infection.
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Albumin
The largest band, made by the liver. A low albumin can reflect illness, poor nutrition or kidney loss. In myeloma it is also one of the numbers used for staging.
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Alpha-1 and alpha-2 globulins
Proteins that rise with inflammation and some liver and kidney conditions. They rarely matter for myeloma on their own.
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Beta and gamma globulins
This is where antibodies sit. Look at the comment for any mention of a band, spike or restriction here. IgA spikes often sit in the beta region.
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M-spike value
If a spike is found, the lab measures it separately. This is the number your haematologist will follow over time.
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The pathologist's comment
The most important line. It says in words whether a band was seen and what test should follow, often immunofixation.
Not sure whether this applies to you?
Ask an oncologistTwo very different patterns
Is it a narrow spike or a broad rise?
Narrow spike (monoclonal)
Broad rise (polyclonal)
One tall, thin peak in the gamma or beta band
A wide, rounded hump across the gamma band
Made by a single clone of plasma cells
Made by many plasma cells reacting to something
Seen in MGUS, myeloma and some lymphomas
Seen with long infections, liver disease and autoimmune illness
Needs immunofixation and a haematology review
Usually points your doctor to the underlying cause instead
The comment line
What might the pathologist's comment say?
These are common phrasings. The wording varies between laboratories, so ask your doctor if yours reads differently.
"M-band seen in gamma region"
A monoclonal protein is present and has been measured. The next steps are immunofixation, free light chains and a full review.
Many people with this line turn out to have MGUS, not myeloma."Faint band, too small to quantify"
Something may be there, but it is too small to put a number on. Immunofixation is usually advised to confirm or rule it out.
"Polyclonal hypergammaglobulinaemia"
A broad rise in normal antibodies, meaning the body is reacting to something. It is not a myeloma pattern, and the cause is looked for elsewhere.
"Hypogammaglobulinaemia"
Low levels of normal antibodies. It can happen in light-chain myeloma and other conditions, and may explain repeated infections.
Often followed by
- A free light chain test
- A urine protein test
"No monoclonal band detected"
No spike was seen. That is reassuring, but it does not rule out light-chain-only myeloma, which the free light chain test checks for.
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What happens next
An M-band was found. What should you do now?
Take the report to a haematologist in the coming weeks rather than waiting months. Most M-bands found by chance turn out to be MGUS, which is watched and not treated. A review is still needed to be sure.
Tests you can expect
Immunofixation to name the protein type, a free light chain test, a complete blood count, calcium, creatinine and albumin. Depending on those, a bone marrow test and a whole-body low-dose CT or PET-CT may follow. CION's haematology team reviews these results together and, where a marrow test or scan is needed, tells you exactly what to ask for and where.
When it should not wait
If the person with the report also has bone pain that is getting worse, great thirst, confusion, falling urine output or new weakness in the legs, go to the nearest emergency department the same day or call 108. Those signs need care before the paperwork is complete.
What this page cannot tell you
It cannot tell you whether your band is harmless or not. Reference ranges differ between laboratories, and a single report is always read with symptoms, other results and repeat tests. Only a haematologist who sees the full set can place it.
Commonly believed
What do people fear wrongly about this report?
"An M-band means it is cancer."
Most M-bands found on routine testing are MGUS. It is not cancer, and most people with it never develop myeloma. It does need regular follow-up.
"A high total protein means myeloma."
Total protein rises with dehydration, infections and liver conditions far more often. The shape of the gamma band matters much more than the total.
"The report was normal, so myeloma is ruled out."
A normal SPEP does not catch every case. Light-chain myeloma can show little or no spike. If symptoms point to myeloma, your doctor may still ask for a free light chain test.
"We should repeat it at another lab to see if it goes away."
Lab-shopping delays the real answer. An M-band is confirmed with immunofixation, not by hoping a second SPEP looks different.
On your report
Which short forms will you see?
- SPEP
- Serum protein electrophoresis, the blood test described on this page.
- UPEP
- The same test done on urine, often on a sample collected over a full day.
- IFE or immunofixation
- A follow-up test that names the protein type, such as IgG kappa.
- A/G ratio
- Albumin divided by the other proteins. A low ratio can mean more globulin, from many causes.
- Bence Jones protein
- Free light chains found in urine.
Questions we are asked
Common questions about serum electrophoresis
Why did my doctor order a protein electrophoresis?
Usually because something else prompted it: a high total protein, a low haemoglobin, kidney trouble, raised calcium, bone pain or a high ESR. It is a screening step. Being asked to do it does not mean your doctor thinks you have myeloma, only that they want to check.
Do I need to fast before the test?
Usually not, although some labs prefer it when other tests are drawn at the same time. Follow the instructions your lab gives. Tell them about recent infections or vaccines, which can change the gamma band, and bring earlier reports if you have them.
What is MGUS, and is it dangerous?
MGUS is a small M-protein with no damage to bones, kidneys or blood and few abnormal plasma cells. It is not cancer. A small share of people go on to develop myeloma or a related condition over years, which is why regular checks are advised rather than treatment.
Can an infection cause an M-band?
Infections usually cause a broad rise, not a sharp spike. Occasionally a small, short-lived band appears during a serious illness and fades later. That is one reason your haematologist may repeat the test after recovery before drawing conclusions.
How big does an M-spike have to be to matter?
Size helps separate MGUS from smouldering myeloma, but size alone does not decide treatment. That depends on damage to bones, kidneys and blood, and on marrow results. A small spike with kidney damage can matter more than a larger one with none.
Why does the report say to do immunofixation?
Electrophoresis finds and measures a band but cannot say what it is. Immunofixation identifies the heavy chain and light chain type. It is also more sensitive, so it can confirm a faint band the first test was unsure about.
Will this test be repeated during treatment?
Yes, if myeloma is confirmed. The M-spike value is one of the main numbers followed through treatment and afterwards. Try to use the same lab each time, because different machines can give slightly different values for the same blood.
Which doctor should we show the report to?
A haematologist, the doctor who treats blood and marrow conditions. Take the SPEP report, any immunofixation or light chain results, recent blood counts, calcium and creatinine, and a list of symptoms with when each started. Dates help the doctor see the trend.
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Sources
- American Cancer Society — Tests to Find Multiple Myeloma
- Cancer Research UK — Myeloma
- NHS — Multiple myeloma
- National Cancer Institute — Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
M-Protein, Free Light Chains and What They TrackWhat the spike value and light chains show over timeThe CRAB Criteria: How Myeloma Is DiagnosedHow doctors decide if an M-band is myelomaMyeloma Explained: What It Does to Bones, Kidneys and BloodPlain-language background on the diseaseBlood cancer guideThe wider family of blood cancers
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Has your report found an M-band?
Tell us what has been found so far. CION's haematology team will read the report with you and tell you which tests should come next. One helpline serves every CION centre.