Agarwal G, Milan C, Mohsin Z, Mahoney S, White G, Stevens P, Connacher S, Osborne P, Eckert R, Sadler R, Ramasamy K, Javaid M K
Balliol College, University of Oxford, Oxford, UK.
Oxfordshire Fracture Prevention Service, Oxford University Hospitals Foundation NHS Trust, Oxford, UK.
Osteoporos Int. 2022 Apr;33(4):937-941. doi: 10.1007/s00198-021-06233-6. Epub 2021 Nov 26.
Multiple myeloma (MM) remains incurable. Although early diagnosis improves outcomes, it has been unclear which populations to target for screening with serum electrophoresis, serum free light chains and urine electrophoresis. Here, we assessed the value of MM screening in a Fracture Liaison Service, finding that 1 per 195 fragility fractures has undiagnosed MM, which can be expedited to Haematology Services.
A key role of the Fracture Liaison Service (FLS) is screening for secondary causes of osteoporosis. In 2019, the Royal Osteoporosis Society recommended that all patients attending FLS who are recommended anti-osteoporosis therapy have universal screening for myeloma based on serum electrophoresis, serum free light chains and urine electrophoresis. Here, we examined the impact of universal myeloma screening within an FLS.
We sampled all patients seen by the Oxfordshire FLS between January and April 2018. The completion rates and outcomes of screening were checked using the hospital and FLS databases.
Of 950 patients identified by the FLS, 628 were eligible for MM screening; 473 (75%) of these were female, and the average age was 78.4 years. Overall, 584 had some form of myeloma screening, of which 577 (92%) had serum electrophoresis, 525 (84%) had serum free light chains and 407 (65%) had urine electrophoresis measured. A total of 327 (59%) patients had complete screening. Three patients (0.5%) had newly diagnosed myeloma and were urgently referred to Haematology Services. Furthermore, 46 (8%) patients had a detectable serum paraprotein with a likely diagnosis of monoclonal gammopathy of uncertain significance (MGUS) and referred for community annual surveillance according to local guidelines.
Addition of universal myeloma screening to laboratory testing identified myeloma in 1 per 195 patients, and its precursor state MGUS in 1 per 13 patients, which may have otherwise been missed. Further analysis with long-term follow-up is needed to clearly define the value of diagnosing MGUS within the FLS setting and establish the benefits vs. costs and methods to improve screening completion rates.
多发性骨髓瘤（MM）仍然无法治愈。尽管早期诊断可改善预后，但尚不清楚哪些人群适合通过血清电泳、血清游离轻链和尿液电泳进行筛查。在此，我们评估了骨折联络服务中MM筛查的价值，发现每195例脆性骨折中有1例患有未确诊的MM，可将其快速转诊至血液科。
骨折联络服务（FLS）的一项关键作用是筛查骨质疏松症的继发原因。2019年，皇家骨质疏松协会建议，所有接受FLS治疗且被推荐进行抗骨质疏松治疗的患者，均应基于血清电泳、血清游离轻链和尿液电泳进行骨髓瘤通用筛查。在此，我们研究了FLS中通用骨髓瘤筛查的影响。
我们对2018年1月至4月期间牛津郡FLS诊治的所有患者进行了抽样。使用医院和FLS数据库检查筛查的完成率和结果。
在FLS识别出的950例患者中，628例符合MM筛查条件；其中473例（75%）为女性，平均年龄为78.4岁。总体而言，584例患者进行了某种形式的骨髓瘤筛查，其中577例（92%）进行了血清电泳，525例（84%）进行了血清游离轻链检测，407例（65%）进行了尿液电泳检测。共有327例（59%）患者完成了全面筛查。3例患者（0.5%）被新诊断为骨髓瘤，并被紧急转诊至血液科。此外，46例（8%）患者血清中可检测到副蛋白，可能诊断为意义未明的单克隆丙种球蛋白病（MGUS），并根据当地指南被转诊进行社区年度监测。
在实验室检测中增加通用骨髓瘤筛查，每195例患者中可识别出1例骨髓瘤，每13例患者中可识别出1例其前驱状态MGUS，否则这些病例可能会被漏诊。需要进行长期随访的进一步分析，以明确在FLS环境中诊断MGUS的价值，并确定其益处与成本以及提高筛查完成率的方法。
