Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care

Seesaghur, Anouchka; Petruski‐Ivleva, Natalia; Banks, Victoria; Wang, Jocelyn Ruoyi; Abbasi, Abdus Sattar; Neasham, David; Ramasamy, Karthik

doi:10.1136/bmjopen-2021-052759

Cited by 16 publications

(14 citation statements)

References 32 publications

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“…Patients with multiple myeloma experience signi cant delays in diagnosis due to non-speci c symptomatology. Early detection of this disease is of great signi cance for prognosis (Seesaghur et al, 2021). At present, serum protein electrophoresis is widely used for clinical screening of M protein, but electrophoresis is not as popular as common biochemical and humoral immunity programs for population screening.…”

Section: Discussionmentioning

confidence: 99%

Early warning values of the kappa/lambda ratio based on serum detection for M-proteinemia diagnosis

Lu,

Zhu,

Huang

et al. 2024

Preprint

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Objective To introduce the kappa/lambda ratio (K/L) to humoral immunity testing reports to improve the detection rate of M-proteinemia disease. Method Patient samples were accumulated from January 2021 to December 2023 in the First Affiliated People’s Hospital of Soochow University. The positive control group included 156 patients of M-proteinemia. These samples were classified according to light chain positivity. The negative group included samples from 4,722 patients with non-plasma-cell monoclonal disease and 742 healthy individuals. Receiver operating characteristic (ROC) curves were used to check the reliability of K/L for M-proteinemia diagnosis. Results For K-type M-proteinemia, the area under the curve (AUC) was 0.932 when K/L was > 2.39, with a sensitivity of 87.3% and specificity of 92.3%. False positives were mainly found in samples with sicca syndrome (16.67%), mantle cell lymphoma (20.37%), and hepatitis (16.0%). For L-type M-proteinemia, when K/L < 1.44, the AUC was 0.863, the sensitivity was 72.9%, and the specificity was 88.8%. The false positives were mainly found in samples with ANCA-associated systemic vasculitis (21.88%), angioimmunoblastic lymphadenopathy–like T-cell lymphoma (31.25%), NK-/T-cell lymphoma (17.39%), T-cell lymphoma (11.11%), systemic lupus erythematosus (16.83%), cirrhosis (15.69%), infection (12.69%), systemic sclerosis (20.93%), and dermatomyositis (13.95%). False negatives were mainly found in AL (52.0%) and ML (36.36%) . Conclusion K/L > 2.39 and K/L < 1.44 should be used as warning values for M-proteinemia. The content of the heavy chain in IgA- or IgM-type M-proteinemia must be considered to improve the detection rate.

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Section: Discussionmentioning

confidence: 99%

Early warning values of the kappa/lambda ratio based on serum detection for M-proteinemia diagnosis

Lu,

Zhu,

Huang

et al. 2024

Preprint

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“…In other first-world countries, in an Embase and Medline meta-analysis, an interval of 163 days from first symptoms to diagnosis in MM is reported [ 47 ]. A UK electronic records data analysis reported that bone pain was recorded, on average 7 months prior to the diagnosis of MM [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa

Chili,

Mackraj,

Rapiti

2023

PLoS ONE

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Objectives To profile the outcome of multiple myeloma (MM) patients treated at a South African tertiary hospital in KwaZulu-Natal (KZN) and to compare MM in HIV-negative patients and MM in people living with HIV (PLWH). Methods A retrospective analysis of patients with MM was conducted over 5 years (2015–2020). Patient demographics, presenting complaints, symptom duration, disease stage, molecular profile, treatment, and survival data were captured. Statistical analysis was conducted using R Statistical software of the R Core Team, 2020, version 3.6.3. Results 135 patients; 79% (n = 106) HIV-negative and 21% (n = 29) PLWH were investigated. 54% (n = 74) females and 57% (n = 76) 51–70-year-olds. The 40-50-year-old patient group had a significantly higher proportion of PLWH (p = 0.032). Pathological fractures were the commonest presenting complaint, 47% (n = 57 and 49% (n = 49) had International Staging System, stage III disease. Fluorescent in-situ hybridization (FISH) MM profiling was completed in 58% (n = 78). Positivity for del 11q22 was found in 23.7% (n = 14) with significantly more HIV-negative patients having the mutation (p = 0.027). Overall, 42.2% (n = 57) achieved 2-year overall survival (OS). There were no significant differences in treatment (p = 0.926) and 2-year survival outcome (p = 0.792) between the two groups. Conclusion The incidence of HIV in newly diagnosed MM patients in KZN was increasing. KZN patient profile differed from other reports by showing female predominance but was similar in advanced-stage presentation and bone fracture predominance. Statistically significant differences between the HIV-negative patients and PLWH were observed in age distribution and mutational landscape. Further studies are required in this area.

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“…Previous studies have not been consistent with some studies reporting shorter diagnostic intervals ( 13 , 16 ), similar diagnostic intervals ( 12 ) and other studies reporting longer diagnostic intervals in MM. ( 10 , 17 ) When comparing diagnostic timeframes for different types of cancer, breast cancer had a median diagnostic delay of 115 days, while bladder cancer had 63 days, cervical cancer had 60 days, and colorectal cancer had 26 days. ( 30 ) Hence, in our study, we demonstrate a longer symptom-to-diagnosis time than commonly reported cancers.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported symptoms and diagnostic journey in Multiple Myeloma

Vijjhalwar,

Song,

Shrestha

et al. 2023

Front. Oncol.

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IntroductionLate presentation of multiple myeloma (MM) heightens the risk of complication risks, including end-organ damage. This study aimed to: 1) detail the diagnostic journey of MM patients, encompassing symptoms, initial diagnoses, and healthcare professionals met; 2) establish the median duration from symptom onset to MM diagnosis; and 3) examine factors linked to timely MM diagnosis within 12 weeks. MethodsA total of 300 adults self-reporting MM were analysed from the Rare and Undiagnosed Diseases cohort Study (RUDY). The RUDY study is a web-based platform, where participants provide dynamic consent and self-report their MM diagnosis and information about their diagnostic journey. This includes the estimated date of initial potential first symptoms, descriptions of these symptoms, the healthcare professionals they consulted, and other diagnoses received before the MM diagnosis. Descriptive statistics, combinatorial analyses and logistic regression analyses were used to describe and examine the diagnostic journey of individuals with MM.ResultsOverall, 52% of the participants reported other diagnoses before MM diagnosis, with musculoskeletal disorders (47.8%), such as osteoporosis, costochondritis, or muscle strains, being the most common. The most prevalent initial reported symptom was back pain/vertebral fractures (47%), followed by chest/shoulder pain, including rib pain and fractures (20%), and fatigue/tiredness (19.7%). 40% of participants were diagnosed by direct referral from primary care to haematology without seeing other healthcare professionals whilst 60% consulted additional specialists before diagnosis. The median time from symptom onset to MM diagnosis was 4 months (IQR 2-10 months, range 0-172). Seeing an Allied Healthcare Professional such as a physiotherapist, chiropractor or an osteopath (OR = 0.25, 95% CI [0.12, 0.47], p <0.001), experiencing infection symptoms (OR = 0.32, 95% CI [0.13, 0.76], p = 0.013), and having chest or shoulder pain (OR = 0.45, 95% CI [0.23, 0.86], p = 0.020) were associated with a lower likelihood of being diagnosed with MM within 12 weeks. Older age (OR = 1.04, 95% CI [1.02, 1.07], p = 0.001) was associated with a higher likelihood of diagnosis within 12 weeks.DiscussionDeveloping resources for allied health professionals may improve early recognition of MM.

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Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care

Cited by 16 publications

References 32 publications

Early warning values of the kappa/lambda ratio based on serum detection for M-proteinemia diagnosis

Early warning values of the kappa/lambda ratio based on serum detection for M-proteinemia diagnosis

Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa

Patient-reported symptoms and diagnostic journey in Multiple Myeloma

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