Mieloma multiplo: riconoscere i sintomi e richiedere gli esami corretti
Introduzione
Perché è importante una diagnosi tempestiva?
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.
5 Year Survival Rate
Adapted from:
Seesaghur A et al. Clinical features and diagnosis of multiple myeloma: a population-based cohort study in primary care. BMJ Open 20213
Speaker
Featured in this video
Professor Andrew Spencer
Head of Malignant Haematology, Stem Cell Transplantation and Head of Myeloma Research at The Alfred Hospital, Australia
Key Takeaways
Recognise early warning signs of Multiple Myeloma
Multiple Myeloma symptoms are non-specific and may mimic the aging 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
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 the correct blood tests to rule out Multiple Myeloma
NICE6 and BSH7 guidelines recommend a number of blood tests to rule out Multiple Myeloma including:
- Serum Protein Studies- to check for M-protein using serum Free Light Chain (sFLC) and serum protein electrophoresis tests
- 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
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.
Adapted from:
Myeloma: Diagnosis and management. NICE Guidelines 2016
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Bibliografia
- Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: causes and consequences of delay in diagnosis. QJM 2007 2007;100 10:635-40/span>
- https://www.mpeurope.org/wp-content/uploads/2022/09/MPE-report_Myeloma-Diagnosis-Across-Europe.pdf
- 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/span>
- 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/span>
- 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
- Myeloma: diagnosis and management, NICE Guideline 35, February, 2016
- 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.
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