Understanding the factors that increase a patient’s likelihood of a multiple myeloma diagnosis can help providers make better-informed decisions for referral.
Multiple myeloma is a common hematologic malignancy that often has nonspecific signs and symptoms. Back pain, fatigue, anemia, and even renal insufficiency can frequently be attributed to common comorbidities, such as diabetes or degenerative arthritis.1
What should trigger suspicion of myeloma? And which patients should this suspicion be higher?
When should multiple myeloma be considered as a possible cause of your patient’s symptoms?
The following signs and symptoms of unknown cause may lead physicians to consider multiple myeloma:1
- Fatigue
- Neuropathy
- Repeated infections
- Bruising/bleeding
- Unintentional weight loss
- Excessive thirst or urination
- Raynaud phenomenon
- Hyperviscosity symptoms
- Persistent bone pain, especially in the back, hips, or skull
- Bone abnormalities, including lytic lesions, bone fractures, and osteoporosis
Patients may also have multiple laboratory abnormalities, such as hypercalcemia, anemia, unexplained proteinuria, elevated total protein or creatinine, low anion gap or albumin, hypo- or hyper-gammaglobulinemia, or elevated ESR.1 These abnormalities merit investigation and can be suggestive of multiple myeloma, especially when a patient has multiple signs/symptoms or risk factors.2
Populations at higher risk of multiple myeloma
People of the following demographic groups have a higher likelihood of having myeloma:
- Older age More than 95% of patients are diagnosed at age 45 or older, and the median age at diagnosis is 69.3 However, the disease often presents 5 or more years earlier in individuals of African or Hispanic descent.4,5 In African Americans, the incidence of myeloma before age 50 is approximately 3 times higher than in Caucasians.5
- African Americans or people of African descent African Americans are twice as likely to be diagnosed with multiple myeloma as Caucasians.3,5 Asians and Pacific Islanders are less likely than Caucasians to be diagnosed with multiple myeloma.3,6
- Male sex Men are slightly more likely than women to develop multiple myeloma.3
- Family history Having a first-degree relative with multiple myeloma or other lympho-hematopoietic cancers increases risk of disease, especially for men and African Americans.7
- Personal history of MGUS Monoclonal gammopathy of undetermined significance (MGUS) significantly increases an individual’s risk of developing multiple myeloma or another plasma-cell or lymphoid disorder.8
Learn more about multiple myeloma’s presentation and diagnosis
Multiple myeloma can be easily overlooked due to its symptoms that overlap with many common conditions. Awareness can help identify patients who may benefit from further testing—especially when these patients have several symptoms, routine lab test abnormalities, or belong to key demographic groups.1,2
Hear from the experts
Learn more about how to recognize and order appropriate testing for multiple myeloma—as well as when to refer to a specialist—in our recent webinar, What hematology experts want PCPs to know about myeloma.
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 Jan;136(1):33-41.
- Shephard EA, Neal RD, Rose P, Walter FM, Litt EJ, Hamilton WT. 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 Feb;65(631):e106-13.
- SEER: Adapted from SEER*Explorer: An interactive website for SEER cancer statistics [Internet]. Surveillance Research Program, National Cancer Institute; 2023 Apr 19. [updated: 2023 Jun 8; cited 2023 Jul 14]. Available from: https://seer.cancer.gov/statistics-network/explorer/. Data source(s): SEER Incidence Data, November 2022 Submission (1975-2020), SEER 22 registries.
- Kaur G, Mejia Saldarriaga M, Shah N, Catamero DD, Yue L, Ashai N, Goradia N, Heisler J, Xiao Z, Ghalib N, Aaron T, Cole D, Foreman R, Mantzaris I, Derman O, Bachier L, Sica RA, Kornblum N, Braunschweig I, Shastri A, Goel S, Verma A, Janakiram M. Multiple Myeloma in Hispanics: Incidence, Characteristics, Survival, Results of Discovery, and Validation Using Real-World and Connect MM Registry Data. Clin Lymphoma Myeloma Leuk. 2021 Apr;21(4):e384-e397
- Waxman AJ, Mink PJ, Devesa SS, Anderson WF, Weiss BM, Kristinsson SY, McGlynn KA, Landgren O. Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood. 2010 Dec 16;116(25):5501-6.
- Padala SA, Barsouk A, Barsouk A, Rawla P, Vakiti A, Kolhe R, Kota V, Ajebo GH. Epidemiology, Staging, and Management of Multiple Myeloma. Med Sci (Basel). 2021 Jan 20;9(1):3.
- Schinasi LH, Brown EE, Camp NJ, Wang SS, Hofmann JN, Chiu BC, Miligi L, Beane Freeman LE, de Sanjose S, Bernstein L, Monnereau A, Clavel J, Tricot GJ, Atanackovic D, Cocco P, Orsi L, Dosman JA, McLaughlin JR, Purdue MP, Cozen W, Spinelli JJ, de Roos AJ. Multiple myeloma and family history of lymphohaematopoietic cancers: Results from the International Multiple Myeloma Consortium. Br J Haematol. 2016 Oct;175(1):87-101.
- Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Kumar S, Cerhan JR, Rajkumar SV. Long-Term Follow-up of Monoclonal Gammopathy of Undetermined Significance. N Engl J Med. 2018 Jan 18;378(3):241-249.