Pietsch Carlotta, Engelhardt Monika, Ihorst Gabriele, Wystrach Laura, Jung Johannes, Schmal Hagen, Frodl Andreas, Wäsch Ralph, Terpos Evangelos, Herget Georg W
Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Comprehensive Cancer Center Freiburg (CCCF), Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
J Bone Oncol. 2025 May 8;52:100685. doi: 10.1016/j.jbo.2025.100685. eCollection 2025 Jun.
Delayed diagnosis of multiple myeloma (MM) and progressive disease (PD) can both increase the risk of skeletal complications and do affects patients' quality of life (QoL). In this prospective study we analyzed skeletal pain, general symptoms and patient-reported outcome measures (PROMs) in patients with MM and their value in detecting symptomatic progression. We evaluated 502 patients, 47 with initial diagnosis (ID) of MM and 455 follow-up patients. At ID, 74% reported bone pain, mostly in the spine. General symptoms, particularly fatigue, were present in 89% of the patients. 88/455 (19%) of the follow-up patients experienced PD. Of these, 65% reported skeletal pain and 81% exhibited general symptoms, with fatigue being the most common. PD was suspected and confirmed as the cause of clinical symptoms in 59/88 (67%) and not suspected in 29/88 (33%). Occurrence and character of bone pain and general symptoms differed significantly between patients with and without PD, as did QoL and health-related status. Logistic regression analysis demonstrated that bone pain at night, pain in various locations, pain of known character with occurrence in different location, pain in the chest, pelvis, and thigh as well as fatigue and weight loss were associated with an increased risk of PD. In conclusion, bone pain and general symptoms are helpful in identifying both MM and PD. PROMs can aid in the diagnosis of PD through symptom-based patient assessment. Serologic and, especially in the case of skeletal complaints, additional radiologic diagnostics are required to confirm suspected and to detect unexpected PD.
多发性骨髓瘤（MM）的延迟诊断和疾病进展（PD）均会增加骨骼并发症的风险，并切实影响患者的生活质量（QoL）。在这项前瞻性研究中，我们分析了MM患者的骨骼疼痛、一般症状以及患者报告的结局指标（PROMs），及其在检测症状性疾病进展方面的价值。我们评估了502例患者，其中47例为MM初诊（ID）患者，455例为随访患者。初诊时，74%的患者报告有骨痛，主要位于脊柱。89%的患者有一般症状，尤其是疲劳。455例随访患者中有88例（19%）出现疾病进展。其中，65%报告有骨骼疼痛，81%有一般症状，最常见的是疲劳。88例中有59例（67%）的疾病进展被怀疑并被确认为临床症状的原因，29例（33%）未被怀疑。有疾病进展和无疾病进展的患者在骨痛和一般症状的发生及特征方面存在显著差异，生活质量和健康相关状况也是如此。逻辑回归分析表明，夜间骨痛、多处疼痛、不同部位出现的已知特征的疼痛、胸部、骨盆和大腿疼痛以及疲劳和体重减轻与疾病进展风险增加相关。总之，骨痛和一般症状有助于识别MM和疾病进展。PROMs可通过基于症状的患者评估辅助疾病进展的诊断。需要血清学检查，尤其是在有骨骼症状的情况下，还需要额外的放射学诊断来确认疑似情况并检测意外的疾病进展。
