Goldschmidt Neta, Zamir Leora, Poperno Alina, Kahan Nathan R, Paltiel Ora
From the Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (NG, LZ, OP); the Enforcement and Inspection Division, Israeli Ministry of Health, Jerusalem, Israel (AP); the Medical Division, Leumit Health Services, Tel-Aviv, Israel (NRK); the School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel (NRK); and the School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (OP).
J Am Board Fam Med. 2016 Nov 12;29(6):702-709. doi: 10.3122/jabfm.2016.06.150393.
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.
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.
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.
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.
多发性骨髓瘤（MM）的临床表现模糊且不具特异性。早期检测在初级保健中构成诊断挑战。我们评估了临床和实验室数据是否能为MM诊断提供早期线索，以及检测时间是否影响生存。
一项基于人群的回顾性研究，纳入2002年至2011年间诊断为MM的110名男性和女性，以及匹配的因背痛就诊的无癌对照。从MM诊断/背痛主诉前2年的医疗记录中提取临床和实验室数据。
在诊断前两年，64名（58%）MM患者主诉背痛，37名（34%）有疲劳或体重减轻。病例对照比较未发现诊断前两年疼痛主诉或感染数量有任何显著差异。然而，MM患者疲劳或体重减轻、贫血、ESR和肌酐升高（所有p<0.001）比对照组更常见，并在多变量分析中被确认为独立预测因素。检测时间（TTD）不影响诊断时的分期、生存或死亡率。
伴有疲劳、体重减轻或实验室检查结果异常的背痛应引起对MM的“红色警示”。尽管如此，我们未发现证据表明TTD会影响MM的初始分期或预后。
