Multiple Myeloma: recognising the symptoms and requesting the correct tests

 

 

 

 

Did you know?

  • More than 50% of Myeloma patients experience a delay in diagnosis of more than 6 months when diagnosed at primary care1
  • More than 70% of patients experience additional symptoms and complications as a result of a delayed diagnosis2

Why is a timely diagnosis important? 

Timely diagnosis and subsequent management of Multiple Myeloma avoids complications that impact patients’ quality of life. Earlier diagnosis and therefore commencement of treatment significantly improves 5-year survival rates of patients.

Primary care providers therefore play a key role in recognising and ruling out Multiple Myeloma at the earlier stages of the disease.

Refer to Haematology_5 Year Survival Rate-1

Adapted from:

Seesaghur A et al. Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care. BMJ Open 20213

Recognise early warning signs of Multiple Myeloma

Multiple Myeloma symptoms are non-specific and may mimic the ageing process or more common conditions encountered at primary care, such as diabetes, hypertension and cardiac disease4.

Patients often present at primary care with bone pain, back pain, aches and generally feeling unwell.

When symptoms are unexplained or persist despite intervention, look out for one or more early warning signs of Multiple Myeloma4.

For further guidance on the investigation of myeloma, complete the RCGP module by clicking here*8 

RCGP logo
Refer to Haematology_Early Warning Signs-1

Professor Andrew Spencer, Head of Malignant Haematology, Stem Cell Transplantation and Head of Myeloma Research at The Alfred Hospital, Australia explains



 
Warning Signs and Symptoms

CRAB events of Multiple Myeloma

As Multiple Myeloma progresses, advanced presentations are associated with end-organ damage. These are referred to as CRAB events of Multiple Myeloma and include hypercalcemia, renal impairment, anaemia, and bone lesions.

 

Request correct blood tests to rule out Multiple Myeloma

NICE6 and BSH7 guidelines recommend a number of blood tests to rule out Multiple Myeloma including:

  • Complete Blood Count- to check for anaemia and raised Erythrocyte Sedimentation Rate (ESR)
  • Serum Biochemistry Panel- to check for raised Calcium, raised Creatinine and low Albumin
  • Serum Protein Studies- to check for M-protein using serum protein electrophoresis and serum Free Light Chain (sFLC) tests
Refer to Haematology_Positive CRAB Criteria-1

Adapted from:

Seesaghur A et al. Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care. BMJ Open 20213

Refer to Haematology

When the patient symptoms and basic laboratory findings are suggestive of Multiple Myeloma, assessment of serum protein studies will help to rule out Multiple Myeloma4.

The survival rate for Multiple Myeloma patients is increased by over one and a half times when the diagnosis is achieved through the primary care referral pathway- rather that the emergency route5.

As the gatekeepers to earlier diagnosis of Multiple Myeloma, primary care practitioners should be alert to the early warning signs. Requesting the best test combination to rule out Multiple Myeloma earlier, allows for a timelier referral pathway to haematology.
Refer to Haematology_sFLC and SPE-2

Click the link above to access the GP Myeloma Diagnostic Tool

Adapted from:

Myeloma: Diagnosis and management. NICE Guidelines NG35 2016

Sive J, et al. British Society of Haematology/UK Myeloma Forum Guidelines 2021

Read the NICE Guidelines below:Click Here

References:

  1. Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: causes and consequences of delay in diagnosis. QJM 2007 2007;100 10:635-40
  2. https://www.mpeurope.org/wp-content/uploads/2022/09/MPE-report_Myeloma-Diagnosis-Across-Europe.pdf
  3. Seesaghur A et al. Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care. BMJ Open 2021;11:e052759. doi:10.1136/bmjopen-2021-052759
  4. Mikhael J et al., Multiple Myeloma for the Primary Care Provider: A Practical Review to Promote Earlier Diagnosis Among Diverse Populations, American Journal of Medicine 2022
  5. Elliss-Brookes L, McPhail S, Ives A, et al. Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets. Br J Cancer 2012;107:1220–6
  6. Myeloma: diagnosis and management, NICE Guideline 35, February, 2016
  7. Sive J, et al. Guidelines on the diagnosis, investigation and initial treatment of myeloma: a British Society for Haematology/UK Myeloma Forum Guideline. British Journal of Haematology. 2021, 193, 245-268.
  8. RCGP Disclaimer: An educational grant was received by RCGP from Binding Site for the production of the course. Editorial and content decisions were made solely by the RCGP

The products referred to on this page may differ from what is commercially available in your country. To find out what is available in your country, please contact your local Binding Site representative.

Not for use in China.