Improving diagnosis requires more than recognizing disease
Multiple myeloma remains one of the more challenging hematologic malignancies to diagnose in primary care. Patients often present with symptoms such as fatigue, persistent bone pain, anemia or renal impairment - clinical findings that overlap with many common conditions encountered in everyday practice, particularly in more elderly patients.1-2
Although early recognition of multiple myeloma remains an important goal, identifying potential signs and symptoms is only the first step. Once multiple myeloma is suspected based on the clinical presentation, appropriate laboratory evaluation is essential to help confirm the diagnosis and facilitate timely referral to a hematologist.
A recent survey of U.S. primary care providers published in the Journal of Applied Laboratory Medicine offers new insight into this stage of the diagnostic pathway.3 The research explored primary care clinicians’ knowledge and confidence in diagnosing multiple myeloma, examined current laboratory testing practices, and identified opportunities for laboratory support to help address gaps in the diagnostic pathway.
For laboratory professionals, these findings reinforce an important opportunity: suppong clinicians with practical, evidence-based diagnostic pathways that make guideline-compliant testing 4-6 easier to implement.
Confidence is an important part of the diagnostic pathway
Primary care providers routinely care for patients with symptoms that may indicate a wide range of conditions. Laboratory testing plays a critical role in narrowing the differential diagnosis and determining appropriate next steps.
The national survey found that while the awareness of the classic clinical presentation of multiple myeloma among primary care providers was generally strong3, many clinicians reported uncertainty when selecting and interpreting laboratory tests for plasma cell disorders.
This distinction matters.
The findings suggest that improving diagnosis may depend not only on recognizing disease, but also on helping clinicians feel confident in selecting the appropriate laboratory evaluation once suspicion arises.3
Confidence, in other words, becomes part of the diagnostic pathway.
Supporting guideline-compliant laboratory testing
Clinical practice guidelines provide clear recommendations for evaluating patients with suspected plasma cell disorders. Organizations including the International Myeloma Working Group (IMWG), National Comprehensive Cancer Network (NCCN) and College of American Pathologists (CAP) recommend laboratory testing strategies designed to support a comprehensive diagnostic evaluation.4-6
Awareness of these recommendations, however, may be limited in busy primary care settings, where clinicians must stay current across a wide range of diseases.3
This is where laboratories can provide meaningful support.
Standardized testing pathways, educational resources, clinical decision support tools and guideline-compliant order sets can help reduce unnecessary variation while making evidence-based testing easier to incorporate into routine clinical practice.3
Rather than adding complexity, these solutions or tools help simplify the diagnostic process.
From evidence to action: the laboratory as a clinical partner
Modern laboratories contribute far more than analytical testing.
Increasingly, they support clinicians through diagnostic stewardship, consultation and education that strengthen decision-making across the patient journey.
Examples include:
- Standardized laboratory order sets and testing pathways
- Clinical decision support integrated into existing workflows
- Interpretive guidance that supports confident result evaluation
- Educational resources that reinforce current guideline recommendations
- Collaboration with hematologists and primary care providers to improve referral pathways
These approaches help laboratories move beyond reporting results to supporting diagnostic excellence.
Continue exploring the evidence
The Journal of Applied Laboratory Medicine publication, “Addressing Diagnostic Delay in Multiple Myeloma: Insights from a National Survey of Primary Care Providers,” provides additional detail on current testing practices, and opportunities to strengthen diagnostic pathways.
Visit the multiple myeloma diagnostic pathway resource center to:
- Read the peer-reviewed publication
- Explore the key survey findings
- Download the Clinical Reference Sheet: Improving the Multiple Myeloma Diagnostic Pathway
- Access additional educational resources on plasma cell disorders and guideline-compliant laboratory testing
References
- Mikhael J, Bhutani M, Cole CE. Multiple myeloma for the primary care provider: a practical review to promote earlier diagnosis among diverse populations. Am J Med. 2023;136(1):33-41.
- Shephard EA, Neal RD, Rose PW, et al. Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: a large case-control study using electronic records. Br J Gen Pract. 2015;65(631):e106-e113.
- Yagnik B, Pauli J, Watson B, Mikhael J. Addressing diagnostics delay in multiple myeloma: insights from a national survey of primary care providers. J Appl Lab Med. 2026.
- Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma.
- Keren DF, Schroeder L, et al. Laboratory detection and initial diagnosis of monoclonal gammopathies: guideline from the College of American Pathologists. Arch Pathol Lab Med. 2022;146(5):575-590.
