Presenting signs of multiple myeloma and the effect of diagnostic delay on the prognosis

Background: presenting symptoms of multiple myeloma (mm) are vague and nonspecific. early detection poses a diagnostic challenge in primary care. we assessed whether clinical and laboratory data could provide early clues to mm diagnosis and whether time to detection affects survival. methods: a retrospective population-based study,including 110 men and women diagnosed with mm between 2002 and 2011,and matched cancer-free controls presenting with back pain. clinical and laboratory data were extracted from medical records for the 2-year period prior to diagnosis of mm/back pain complaint. results: during the two years prior to diagnosis 64 (58%) of mm patients complained of back pain,and 37 (34%) suffered from fatigue or weight loss. case-control comparisons did not reveal any significant differences in the number of pain complaints or infections in the two-year prediagnostic period. however,fatigue or weight loss,anemia,elevated esr and creatinine (p < 0.001 for all) occurred more frequently in mm patients than controls and were confirmed as independent predictors in multivariated analysis. ttd did not impact stage at diagnosis,survival,or mortality. conclusions: back pain accompanied by fatigue,weight loss or abnormal lab results should raise a red flag warning of mm. nonetheless,we did not find evidence that ttd influences the initial stage or the prognosis of mm.